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Columbia  MniberöitpCio^v^ 
in  tf)e  Citj>  of  i^etö  Pork 

College  of  ^öpöicianö  anb  ^urgeonö 


3^ef  erente  ^.itirarp 


7. 


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http://www.archive.org/details/suppressionoftuOObehr 


WORKS  TRANSLATED  BY 
DR.    CHARLES    BOLDUAN 

PUBLISHED   BY 

JOHN  WILEY  &  SONS. 


Immune  Sera  :  Hsemolysins,  Cytotoxins,  and  Pre= 
cipitins.  By  Prof.  A.  Wassermann,  M.D.,  Uni- 
versity of  Berlin.  Authorized  Translation  by 
Charles  Bolduan,  M.D.  i2mo,  ix -|- 76  pages. 
Cloth,  $1.00. 

The  Suppression  of  Tuberculosis. 

Together  with  Observations  concerning  Phthisio- 
genesis  in  Man  and  Animals,  and  Sug^gestions  con- 
cerning the  Hygiene  of  Cow  Stables  and  the 
Production  of  Milk  for  Infant  Feeding,  with  Special 
Reference  to  Tuberculosis.  By  Professor  E.  von 
Behring,  University  of  Marburg.  Authorized  Trans- 
lation by  Charles  Bolduan,  M.D.  i2mo,  vi  +  85 
pages.     Cloth,  $1.00. 


THE 

SUPPRESSION  OF  TUBERCULOSIS 

TOGETHER    WITH 

OBSERVATIONS  CONCERNING  PHTHISIOGENESIS 

IN   MAN   AND   ANIMALS 

AND 

SUGGESTIONS   CONCERNING   THE   HYGIENE  OF   COW 
STABLES  AND  THE  PRODUCTION  OF   MILK   FOR 
INFANT  FEEDING,  WITH  SPECIAL  REFER- 
ENCE TO  TUBERCULOSIS 


BY 

Professor   E.  von  BEHRING 

Un  ivers ity  o/  Ma r l>  u  r^ 


AUTHORIZED     TRANSLATION 

BY 

CHARLES  BOLDUAN,  M.IX.,,  -^  , 


FIR^  THOUSANTt 


'^^clemy  of  Nled^c^- 


NEW  YORK 

JOHN  WILEY    &    SONS 

London  :   CHAPMAN    &    HALL,   Limited 

1904 


Copyright.   1904, 

BY 

CHARLES   BOLDUAN 


POBKKT  ■DKTOTMONT),    PT5TNTHT?,    NKW  YORK 


TRANSLATOR'S   PREFACE. 


The  suppression  of  tuberculosis  is  of  universal 
interest.  A  disease  which  is  so  wide-spread  and 
which  attacks  the  human  race  from  so  many  points 
can  be  successfully  combated  only  by  the  coopera- 
tion of  many  different  agencies.  It  is  therefore  of 
great  importance  that  the  origin  of  tuberculosis  be 
well  understood  not  only  by  physicians,  but  by 
many  outside  the  medical  profession,  such  as  dairy- 
and  cattle-men,  officers  of  health  boards,  sanitary 
engineers,  etc.  In  order  to  present  to  the  English 
reader  in  a  concise  and  authentic  form  von  Behring 's 
views  on  the  origin  and  suppression  of  tuberculosis, 
the  translator  has  made  selections  of  von  B  erhing 's 
articles  from  several  different  sources. 

The  princi|)al  article  is  translated  from  a  lecture 
delivered  in  Cassel,  September  25,  1903.  In  reply 
to  certain  criticisms  of  a  statement  in  this  lecture, 
von  Behring  published  an  explanation  in  the 
Deutsche  medizinische  Wochenschrift,  No.  6,  1904. 
This  is  reproduced,  in  part,  in  the  Appendix.  The 
two    articles,    ''Observations    on    Phthisiogenesis " 


m 


iv  TRANSLATOR'S   PREFACE. 

and  '^  Suggestions  concerning  the  Hygiene  of  Cow 
Stables"  are  taken  from  Beiträge  zur  experimen- 
tellen Therapie^  No.  8,   1904. 

Each  article,  with  the  exception  of  the  one  just 
mentioned,  is  reproduced  in  full  and  without 
changes.  In  a  subject  of  such  controversial  nature 
it  is  essential  to  reproduce  faithfully  the  exact 
meaning  of  the  original,  and  this  has  been  done  even 
though  at  times  it  may  have  led  to  awkwardness 
of  expression.  In  a  few  cases  where  an  exact 
equivalent  for  the  German  could  not  be  found  the 
translator  has  used  the  nearest  English  equivalent, 
followed  by  the  German  word  in  brackets. 

Charles  Bolduan. 

Brooklyn,  July,  1904. 


CONTENTS. 


PAGE 

Thb  Suppression  of  Tuberculosis  (the  Cassel  Lecture)  .       i 

Observations   concerning   Phthisiogenesis   in   Man   and 

Animals 45 

Suggestions  concerning  the  Hygiene  of  Cow  Stables  and 

THE  Production  of  Milk  for  Infant  Feeding 60 

Synopsis  of  the  Method  of  Making  Protective  Inocula- 
tions OF  CiTTLE  in  Agricultural  Practice 69 

Conditions  concerning  the  Distribution  of  the  Protec- 
tive Virus 75 

Appendix 81 


THE  SUPPRESSION  OF  TUBERCULOSIS. 


THE   CASSEL   LECTURE.^ 

Although  in  this  lecture  I  have  planned  to  dis- 
cuss mainly  the  suppression  of  human  tuberculosis, 
my  experiences  with  bovine  tuberculosis  cannot 
be  omitted;  for  not  only  have  I  strong  reasons  for 
believing  that  bovine  tuberculosis  plays  an  im- 
portant role  in  the  etiology  of  human  tuberculosis, 
but  I  am  also  firmly  convinced  that  by  means  of 
the  knowledge  gained  from  the  study  of  bovine 
tuberculosis,  we  shall  be  able  to  prevent  to  a  great 
extent  human  tubercular  consumption,  and  favor- 
ably influence  the  course  of  already  existing  tuber- 
cular diseases. 

Both  human  pulmonary  consumption  and  perl- 
sucht  of  cattle  (which  often  leads  to  consumption) 
are  caused  by  minute  vegetable  organisms,  which 
it  is  impossible  to  differentiate  either  microscopi- 
cally or  culturally, — the  tubercle  bacilH  of  Koch. 
It  is  impossible  to  have  either  tubercular  pulmonary 

*  Address   delivered   at  the  seventy-fifth  meeting  of  Naturalists  and 
Physicians  in  Cassel,  September  25,  1903. 


2  THE  SUPPRESSION  OF   TUBERCULOSIS. 

consumption  or  perlsucht  without  the  presence  of 
these  tubercle  bacilH ;  and  no  matter  how  suscepti- 
ble to  tuberculosis  an  individual  may  be,  a  tuber- 
cular infection  cannot  take  place  if  these  bacilli  be 
absent. 

In  order  for  the  disease  to  develop,  three  factors 
must  always  be  present:  first,  the  susceptible  or- 
ganism; second,  the  vegetable  parasite;  and  third, 
the  necessary  opportunity  to  infect.  Under  the 
last  I  tinderstand  all  the  conditions  necessary  to 
bring  the  virus  to  such  a  part  of  the  living  organism 
as  will  enable  it  to  enter  either  into  the  circulation 
or  into  other  body  juices. 

Every  human  individual  is  by  nature  susceptible 
to  the  action  of  tubercle  bacilli  which  have  entered 
his  body  juices.  This  is  true  not  only  of  human 
but  also  of  bovine  tubercle  bacilli.  I  emphasize 
this  now  but  shall  give  my  proofs  later.  But  not 
every  tubercular  infection  of  the  tissues  leads  to 
consumption.  Frequently  the  tubercular  infection 
is  followed  by  such  slight  disturbances  of  health 
that  it  remains  latent  throughout  an  entire  life- 
time and  is  only  discovered  at  autopsy. 

Whether  the  entrance  of  tubercle  bacilli  into  the 
tissue  juices  of  an  individual  shall  end  disastrously 
or  not,  depends  on  a  large  number  of  factors. 
Congenital  differences  in  the  degree  of  susceptibility 
undoubtedly  play  a  subordinate  role.  A  more 
important  factor  is  the  degree  of  virulence  of  the 
inoculated    virus,    and    this    may    fluctuate   within 


THE  CASS  EL   LECTURE.  3 

wide  limits.  Of  great  importance  also  is  the  am.ount 
of  the  virus  and  whether  the  inoculation  is  single, 
repeated,  or  almost  continuous  for  a  longer  time. 
Of  transcendent  importance,  however,  are  the  age 
of  the  individual,  his  physiological  or  pathological 
condition  at  the  time  of  infection,  other  previous 
diseases,  mode  of  feeding,  occupation,  hygienic  con- 
ditions of  his  surroundings,  etc.  In  short,  all  that 
we  understand  by  the  term  acquired  susceptibility, 
or  acquired  predisposition.  Finally,  I  must  men- 
tion the  location  and  character  of  the  point  of  en- 
trance of  the  virus. 

We  see  at  once,  therefore,  that,  in  the  analysis 
of  a  tubercular  infection,  it  is  not  sufficient  to  have 
determined  the  presence  of  the  three  necessary 
factors,  susceptibility,  the  tubercular  virus,  and 
the  opportunity  for  infection.  If  we  wish  to  under- 
stand the  manifold  variety  of  the  reaction  phe- 
nomena exhibited  by  an  individual  infected  with 
tubercular  virus,  we  must  thoroughly  study  all 
the  conditions  above  mentioned  as  well  as  a  great 
variety  of  accidental  conditions. 

Nowadays  the  term  tuberculosis  is  applied  to 
everything  which  constitutes  a  change  in  the  or- 
ganism excited  by  the  entrance  into  it  of  tubercle 
bacilli.  In  statistics,  galloping  consumption  is 
thus  classed  with  tubercular  local  infection  of  a 
joint,  gland,  abdominal  organ,  of  a  little  nodule  in 
the  skin  of  the  face,  etc.  Calcified  as  well  as  other 
remains  of  previous  lesions  are  classed  as  tubercular. 


4  THE   SUPPRESSION    OF    TUBERCULOSIS. 

We  have  every  reason  to  praise  as  a  great  scientific 
advance  the  discovery  that  in  manifestations  so 
varied  in  their  importance  to  Hfe  and  health  the 
etiological  factor  is  the  same.  One  must  not, 
however,  make  the  mistake  of  classing  as  one  and 
the  same  thing  tubercular  infection  and  consump-> 
tion  and  prognosticate  an  inevitable  and  painful 
end  on  making  the  diagnosis  of  tubercular  infection. 
How  little  the  facts  justify  such  a  course  is  seen 
in  the  statistics  of  bovine  tuberculosis  and  will  be 
seen  also  when  I  come  to  speak  of  the  statistics 
of  human  tuberculosis. 

In  studying  the  statistics  of  bovine  tuberculosis 
of  this  province,  I  have  had  the  hearty  support  of 
the  government  officials  as  well  as  of  many  county 
veterinary  surgeons.  After  my  colleague,  Dr. 
Römer,  had  examined  several  thousand  head  of 
cattle  we  ceased  our  labors  because  we  were  con- 
fronted by  the  depressing  fact  that  larger  herds  of 
cattle  were  rare'y  ever  free  from  tuberculosis.  As 
a  test  to  discover  the  presence  of  tuberculosis  we 
made  use  of  small  in  ections  of  Koch's  tuberculin. 
We  are  aware  that  there  are  tuberculous  animals 
which  do  not  react  to  this  test.  On  the  other  hand, 
if  the  method  of  making  the  test  he  faultless,  a  posi- 
tive reaction  always  indicates  that  the  animal  in 
question  is  infected  with  tuberculosis.  Our  figures 
for  these  cases  are  therefore  without  doubt  too 
low.  Despite  this,  and  despite  the  fact  that  young 
cattle,    even    though    infected    with    tuberculosis, 


THE  CASS  EL   LECTURE.  5 

often  do  not  react  to  the  usual  dose  of  tuberculin, 
we  found  frightfully  high  figures  for  herds  of  more 
than  twenty  animals.  We  had  to  admit  that  in  this 
respect  we  were  no  better  off  than  other  countries. 
I  will  cite  one  of  the  most  experienced  of  the  in- 
vestigators of  tuberculosis,  Prof.  Bang  of  Copen- 
hagen, who  says  that  in  Denmark,  in  stables  of  more 
than  fifty  head  of  cattle,  an  average  of  60%  of  the 
animals  .are  tuberculous.  Bang  says  further:  ''If 
one  is  dealing  with  a  large  herd  in  which  tuber- 
culosis has  existed  for  many  years,  one  may  as 
well  omit  testing  the  full-grown  animals.  Most  of 
them  will  react,  even  though  they  appear  perfectly 
healthy.''  To  this,  as  a  result  of  many  years'  obser- 
vation, I  should  like  to  add,  and  though  they  may 
apparently  remain  perfectly  healthy  for  their  entire  life. 
As  a  rule  a  herd  of  cattle  on  a  large  farm,  though 
infected  with  tuberculosis,  presents  a  fine  appear- 
ance. Nor  does  their  state  of  nutrition,  milk  pro- 
duction, or  calf -raising  leave  anything  to  be  desired. 
Now  and  then  a  cow  coughs,  or,  despite  plentiful 
food,  loses  flesh.  This  animal  is  put  aside  and  the 
herd,  as  such,  resumes  its  magnificent  appearance. 
If  in  a  herd  reacting  to  tuberculin  things  are 
allowed  to  go  on  in  this  way  for  a  number  of  years, 
especially  if  the  cattle  be  barn-fed,  then,  to  be  sure, 
the  number  of  coughing  animals  increases,  the  off- 
spring deteriorate,  the  milk  and  meat  production 
decrease,  until  finally  the  scourge  of  tuberculosis  is 
plainly  marked. 


6  THE  SUPPRESSION  OF    TUBERCULOSIS. 

Carefully  conducted  epizootic  researches  in  otir 
province  have  led  me  to  the  discovery  that  a  single, 
native,  mountain  breed  of  cattle,  that  of  Vogelsberg, 
was  probably  free  from  tuberculosis  as  late  as  twelve 
years  ago.  Through  imported  cattle  the  tuber- 
cular infection  was  then  introduced.  But  even 
now  the  percentage  of  animals  responding  to  the 
tuberculin  test  is  about  one-quarter  that  of  other 
breeds.  What  is  curious,  however,  in  these  cattle 
is,  that  whereas,  according  to  common  experience 
in  all  other  breeds,  the  percentage  of  reacting  animals 
increases  with  their  age,  in  these  Vogelsberg  cattle 
the  percentage  from  the  fifth  year  on  even  decreases. 
This  may  depend  on  the  smaller  number  of  animals 
infected  five  years  ago.  Some  of  the  exceptions, 
however,  I  must  accoimt  for  by  the  definite  healing 
of  lesions  and  a  consequent  disappearance  of  the 
reaction.  The  favorable  termination  of  the  tuber- 
culosis in  these  Vogelsberg  cattle  I  ascribe  to  the 
smaller  accumulation  of  the  tubercular  virus  in 
the  still  relatively  little-infected  stables,  or,  what 
amoimts  to  the  same  thing,  to  a  smaller  dose  of  the 
virus  infecting  the  suckling  calves.  These,  of  course^ 
take  up  the  infecting  agent  not  only  from  the  mother 
cow,  hut  also  from  the  other  cattle.  One  can  plainly 
see  how  the  percentage  of  reacting  cattle  in  this 
Vogelsberg  breed  increases  from  year  to  year,  and 
I  feel  certain  that  ten  years  hence  these  cattle 
will  be  as  badly  off  in  this  respect  as  other  breeds, 
provided  measures  are  not  taken  to  check  the  ad- 


THE  CASSEL  LECTURE.  7 

vancing  infection.  Such  measures  we  have  had  at 
our  command  for  some  time,  and  their  usefulness  has 
been  thoroughly  proven.  I  know  of  a  large  number 
of  herds  which,  by  means  of  Bang's  rules,  have 
been  made  free  from  tuberculosis  and  kept  so.  It 
is,  however,  an  expensive  procedure  and  requires 
the  constant  supervision  of  an  expert,  and  even 
then  is  usually  possible  only  on  large  estates  where 
any  reacting  animal  may  immediately  be  sepa- 
rated from  the  unaffected  herd.  When,  therefore, 
I  published  a  method  of  protective  inoculation 
against  tuberculosis,  one  which  I  had  proved  in  my 
own  stables,  I  was  pleased  with  the  spirit  of  hearty 
cooperation  shown  by  the  owners  of  large  dairies 
who  had  already  experimented  largely  with  Bang's 
procedures. 

Through  the  courtesy  of  Coimt  Zedlitz  I  was 
enabled  to  make  numerous  preventative  inocula- 
tions on  cattle  in  three  coimties  of  Hesse-Nassau; 
from  there  the  experiments  were  extended  to  the 
neighboring  grand  duchy  of  Hesse,  and  to  the  large 
dairy  of  Bolle  in  Köpenik  near  Berlin.  As  a  result 
of  this  work  I  was  able  in  the  beginning  of  this 
year  to  establish  the  harmlessness  of  the  procedure. 
Since  then  I  have  had  abundant  opportunity  to  in- 
oculate calves  under  three  months  on  the  immense 
Hungarian  possessions  of  Prince  Ludwig  of  Bavaria; 
also  on  those  of  Archduke  Frederick  of  Austria. 
Under  my  direction  scientific  researches  regarding 
the   protection   afforded  by  the   inoculations   have 


8  THE   SUPPRESSION  OF   TUBERCULOSIS. 

been  undertaken  by  Prof.  Eber  in  the  veterinary 
school  of  the  University  of  Leipzig  and  by  Prof. 
Schlegel  in  that  of  the  University  of  Freiburg; 
further  also  by  Ober-med.  Rath  Lorenz  in  Darm- 
stadt and  by  Prof.  Hutyra  in  Budapest.  In 
Marburg  I  myself  have  made  studies  on  highly  im- 
munized cattle  regarding  the  production  of  anti- 
bodies, have  reared  calves  on  cows  immune  to 
tuberculosis,  and  have  investigated  the  subject 
of  immune  milk. 

All  the  details  have  been  carefully  recorded. 
Some  of  these  protocols  have  already  been  printed, 
and  at  the  close  of  this  year  I  hope  to  commence 
the  publication  and  working  out  of  the  rest  of 
this  enormous  mass  of  material  in  my  ''Beiträge 
ztir  experimentellen  Therapie ^ 

In  the  mean  time,  however,  the  practical  appli- 
cation of  my  immunizing  procedure  continues 
steadily  to  gain  in  extent.  Austrian  as  well  as 
Swedish  investigators,  sent  by  their  governments 
to  study  the  inoculation  technique  at  Marburg, 
are  to  make  extensive  inoculations  in  their  native 
countries.  The  government  of  the  grand  duchy 
of  Hesse  has  ordered  that  the  coimties  use  part 
of  their  police  fimd  to  defray  the  expense  of 
inoculating  all  calves  free  of  charge,  provided  that 
the  owners  bind  themselves  to  allow  the  county 
veterinarian  to  supervise  the  inoculated  animals. 
From  all  sides  I  receive  requests  for  this  preventa- 
tive virus. 


THE  C ASSEL   LECTURE.  9 

Until  recently  I  prepared  this  virus  myself  and 
distributed  it  free  of  charge  with  the  help  of  private 
funds.  I  was  able  to  do  the  entire  scientific,  tech- 
nical, and  administrative  work  with  only  a  few 
assistants.  But  this  is  no  longer  possible,  for  the 
expenses  have  outgrown  not  only  my  financial 
means,  but  also,  even  with  great  zeal  for  the  work, 
my  bodily  strength.  I  should  gladly  have  post- 
poned any  change  in  the  manufacture  and  distrib- 
ution of  the  virus  tintil  the  Prussian  government 
was  ready  to  take  charge  of  the  entire  matter. 
But  the  daily  increasing  labor  has  made  it  necessary 
for  me  to  rid  myself  of  this  burden  now,  and  I  have 
therefore  provisionally  arranged  that  the  firm  of 
Drs.  Seibert  &  Ziegenbein  of  Marburg  undertake 
the  manufacture. 

That  this  free  distribution  of  the  protective  virus 
for  tuberculosis  of  cattle  has  been  completely  jus- 
tified is  seen  by  the  report  of  Koch's  Institute,  en- 
titled, '*  Ueber  Immunisierung  gegen  Tuber culose.''^ 
To  be  sure,  this  report  contains  nothing  positive 
that,  as  a  result  of  a  large  number  of  experiments, 
I  had  not  already  maintained  for  some  years.  And 
it  lacks,  what  is  especially  important  in  the  practical 
immunization  of  cattle,  namely,  proof  in  the  form 
of  protocols.  Possibly  these  were  omitted  because 
they  would  fail  to  substantiate  Neufeld 's  assertion 
that  Koch,  previous  to  my  publication  regarding 
protective  inoculations  of  cattle  with  living  tubercle 
bacilli,  had  already  made  use  of  the  same  procedure. 


äo  THE  SUPPRESSION   OF    TUBERCULOSIS. 

I  cannot  refrain  from  observing  that  Neufeld  treats 
this  question  of  priority  in  rather  unusual  fashion, 
for  he  now  claims  for  Koch  an  immunizing  pro- 
cedure which  I  had  published  as  long  ago  as  1901. 
It  would  surely  have  been  more  reasonable  to  have 
made  these  claims  sooner,  before  the  success  of  the 
method  became  so  generally  recognized  in  agricultural 
circles.  Finally,  I  must  criticise  the  author  for 
making  similar  uncalled-for  claims  for  the  English 
investigator  Macfadyan.  As  the  one  most  con- 
cerned, such  claims  might  have  been  made .  by 
Macfadyan  himself,  yet,  so  far  as  I  know,  that  in- 
vestigator has  not  even  suggested  such  a  thing. 
In  the  case  of  my  diphtheria -serum  discovery  I 
can  entirely  overlook  similar  baseless  and  unjust 
claims  for  Roux  and  for  Ehrlich.  Such  claims 
have  often  been  made  by  medical  authors,  but 
neither  Roux  nor  Ehrlich  has  ever  authorized 
such  a  perversion  of  facts. 

However,  apart  from  these  inaccuracies,  the 
report  of  Neufeld  regarding  Koch's  tubercular 
immunizing  experiments  shows  an  agreement  with 
my  results  which  extends  into  the  smallest  details. 
This,  then,  must  demonstrate  to  the  world  the 
absolute  reliability  of  my  immunizing  principle. 
The  entire  suppression  of  bovine  tuberculosis  is 
now  only  a  question  of  conscientious  and  properly 
conducted  protective  inoculations,  and,  of  course, 
also  a  matter  of  time. 

Just  now  I  am  studying  the  important  practical 


THE   C ASSEL   LECTURE.  II 

point  which  for  a  long  time  occupied  the  attention 
of  students  of  vaccination.  We  now  know  that 
protection  against  variola  is  only  then  secured 
when  the  vaccination  is  followed  by  a  typical  in- 
flammatory reaction.  Are  the  requirements  the 
same  for  bovine  tuberculosis?  This  I  cannot  yet 
definitely  answer;  and  even  under  the  most  favor- 
able conditions  I  shall  be  able  to  answer  it  only  after 
a  lapse  of  two  years.  By  that  time  the  calves  that 
were  injected  only  once  and  that  did  not,  so  far  as 
we  could  ascertain,  react  to  the  inoculation,  will 
have  grown  to  maturity. 

Another  important  problem,  one  regarding  heredi- 
tary immunity,  is  already  nearer  solution.  I  be- 
lieve I  am  warranted  in  saying  that,  as  a  rule,  the 
immunity  against  tuberculosis  is  not  transmitted 
by  the  cow  to  her  calf  during  intra-uterine  life. 
One  can  readily  be  deceived  by  cases  of  apparent 
hereditary  immunity.  For  example,  in  examining 
the  fourteen -day -old  calf  of  a  highly  immunized 
cow,  I  found  the  calf  to  possess  a  comparatively 
high  degree  of  immunity  against  perlsucht  bacilli. 
Without  my  previous  experience  with  infantile  im- 
munity to  guide  me,  I  might  easily  have  been  led 
into  the  error  of  assuming  this  to  be  a  case  of  heredi- 
tary immunity.  Comparative  tests,  however,  have 
made  it  very  probable  that  the  immunity,  un- 
doubtedly possessed  by  this  calf,  was  derived  from 
the  milk  of  the  immune  cow  with  which  the  calf 
was  nourished. 


12  THE   SUPPRESSION  OF   TUBERCULOSIS. 

It  will  still  be  some  time  before  I  can  present  any- 
experimental  evidence  to  show  whether  a  cow, 
less  highly  immunized  than  the  one  just  mentioned, 
also  produces  a  milk  which  possesses  protective 
immunity,  and  if  so,  how  far  it  is  possible  to  in- 
crease this  property;  whether  such  a  milk  can  be 
used  to  combat  human  tuberculosis;  and  finally, 
whether  it  can  be  transported  long  distances  with- 
out losing  this  property.  I  have,  to  be  sure,  every 
reason  to  hope  that  we  are  on  the  right  track  when 
we  believe  that  immune  milk  constitutes  a  remedy 
for  tuberculosis  with  which  no  other  remedy  can 
even  remotely  compare.  You  will,  I  am  sure, 
believe  that  I  shall  leave  nothing  undone  which 
will  lead  to  a  realization  of  these  hopes. 

Right  here,  perhaps,  it  is  well  to  say  that,  for 
the  purpose  of  making  very  careful  therapeutic 
experiments,  I  am  delivering  immune  milk  to  only 
a  few  of  my  medical  friends.  I  cannot,  therefore, 
meet  the  many  demands  for  this  remedy  coming 
from  medical  and  other  sources.  They  are  so  nu- 
merous that  I  cannot  even  answer  them  all.  When, 
as  a  result  of  these  clinical  experiments,  the  condi- 
tions and  restrictions  are  determined  under  which 
immune  milk  exerts  its  therapeutic  action,  I  shall 
make  public  all  the  facts  in  regard  to  this  remedy, 
and  thus  make  it  accessible  to  every  one. 

In  the  mean  time  I  believe  it  will  serve  a  very 
useful  purpose  if  I  publish  in  readily  comprehensible 
form  the   scientific  facts   on  which   my  plans   for 


THE   C ASSEL   LECTURE.  13 

the  suppression  of  tuberculosis  rest.  With  this,  of 
course,  will  come  a  discussion  of  controversial 
points  in  the  field  of  tuberculosis  investigation 
which  have  attracted  the  attention  not  only  of  the 
medical  profession,  but  also  of  the  laity. 

I  shall  commence  with  the  question  as  to  what 
relations  exist  between  human  and  bovine  tubercle 
bacilh.  Two  years  ago,  in  London,  Koch  said  that 
the  excitants  of  bovine  perlsitcht  have  nothing  to 
do  with  human  consumption.  If  this  be  true,  then 
I  must  at  once  admit  that  my  hopes  regarding  the 
utiUty  of  cattle  immunization  for  human  thera- 
peutic purposes  have  very  little  foundation.  It  is 
well  known  that  the  protection  afforded  by  im- 
mune bodies  excited  by  the  injection  of  any  virus 
extends  only  to  the  same  species  of  virus,  not  to 
that  of  different  species.  Nor,  in  our  entire  investi- 
gations in  immunity,  do  we  possess  a  single  ex- 
ample showing  the  possibihty  of  protecting  animals 
or  man  by  means  of  one  infectious  agent  against 
the  action  of  another  of  a  different  species.  All 
this  is  now  so  well  known  that  I  need  not  discuss 
it.  When,  therefore,  the  researches  at  the  Koch 
Institute  show  that  it  is  possible  to  protect  goats, 
donkeys,  and  cattle  against  perlsucht  by  inoculating 
them  with  human  tubercle  bacilh,  does  it  not  show 
that  in  these  diseases  there  is  no  difference  of  species? 

•According  to  the  recently  expressed  opinion  of 
his  co-workers,  Schütz  and  Neufeld,  Koch  in  his 
London  address  did  not  maintain  that  there  is  a 


14  THE  SUPPRESSION   OF   TUBERCULOSIS. 

difference  in  species.  He  merely  maintained  that 
the  virus  of  human  consumption  is  not  identical 
with  the  virus  of  bovine  perlsucht,  and  that,  like- 
wise, bovine  tuberculosis  is  not  identical  with 
human  tuberculosis.  That,  to  be  sure,  would  be 
something  quite  different  from  what  the  rest  of  the 
world  understood.  Human  pulmonary  consump- 
tion and  bovine  perlsucht  are  anatomically  so 
dissimilar  that  it  required  extraordinarily  clever 
researches  and  keen  reasoning  to  lead  to  the  dis- 
covery of  a  common  etiological  factor  in  these 
diseases.  But  one  can  easily  go  further  than  this. 
One  can  maintain  without  exaggeration  that  tuber- 
cular lupus,  tubercular  scrofula,  and  other  human 
tuberculosis  localized  in  joints,  serous  surfaces, 
etc.,  are  just  as  little  identical  with  pulmonary 
consumption  as  are  the  cases  of  bovine  perlsucht. 
The  term  identical  does  not  even  fit  all  cases  of 
consumption.  Strictly  speaking,  a  process  or  thing 
is  identical  only  with  itself..  Certainly  not  all 
tubercle  bacilli  are  identical,  nor  yet  all  kinds  of 
tubercle  bacilli.  Koch's  assertion  that  there  is 
an  essential  difference  between  human  and  bovine 
tubercle  bacilli,  and  that  these  differences  are  not 
bridged  by  any  connecting  links,  provoked  the 
strongest  opposition.  This  assertion  has  since 
called  forth  observations  from  all  over  the  world 
which  positively  demonstrate  the  existence  of 
intermediary  stages  in  the  virulence  of  tubercle 
bacilli  derived  from  mammals.     Generally,  tubercle 


THE   C ASSEL   LECTURE.  1 5 

bacilli  derived  from  cattle  are  more  virulent  for  all 
animal  species,  thus  far  examined,  than  are  human 
tubercle  bacilli.  And  the  opinion  is  constantly 
gaining  ground  that  bovine  tubercle  bacilli  are  also 
more  virulent  for  man. 

In  the  scientific  controversy  as  to  whether  the 
virus  of  consumption  and  that  of  perlsucht  belong 
to  the  same  species  or  not,  various  misunderstand- 
ings have  prevented  an  agreement.  Very  often 
the  terms  ''similar  species"  and  "different  species" 
have  been  used  in  a  different  sense.  It  is,  of  course, 
wholly  a  matter  of  individual  judgment  where  to 
draw  the  line  limiting  the  membership  of  what,  in 
our  minds,  constitutes  a  species.  Even  if  we  apply 
Darwin's  definition  and  include  under  the  term 
"species"  only  "organisms  of  similar  origin,"  the 
term  is  still  very  elastic.  However,  in  the  light  of 
our  present  biological  knowledge,  based  on  Darwin's 
theory  of  evolution,  we  are  under  no  circum- 
stances permitted  to  take  as  a  criterion  for  like  and 
unlike  species  such  an  easily  influenced  factor  as  the 
degree  of  virulence,  i.e.,  the  capacity  for  giving  rise 
to  pathological  changes  in  another  organism.  Now- 
adays all  botanists  and  zoologists  are  agreed  on  this, 
that  membership  in  a  species  is  determined  by  the 
origin  of  the  organism.  An  anthrax  culture,  which 
has  been  made  entirely  avirulent  by  means  of 
Pasteur's  procedure  for  reducing  virulence,  surely 
belongs  to  the  same  species  as  does  the  virulent 
variety  from  which  it  was  derived.     And  in  this 


l6  THE  SUPPRESSION   OF   TUBERCULOSIS. 

case  the  difference  in  the  degree  of  virulence  is  far 
greater  than  it  ever  is  between  human  and  bovine 
tubercle  bacilli.  If  we  keep  in  mind  all  the  func- 
tional differences  that  have  experimentally  been 
shoAvn  to  exist  between  tubercle  bacilli  which  have 
long  lived  in  a  human  body  and  those  which  have 
long  lived  in  a  bovine  body,  we  shall  surely  not  go 
wrong  when  we  assume  that  with  a  little  patience 
and  expert  knowledge  we  shall  be  able  to  make 
these  two  varieties  absolutely  similar  again,  even 
in  respect  to  their  virulence. 

Passing  now  to  the  discussion  of  the  real  subject 
of  my  lecture  I  shall  try  to  give  you  an  idea  of 
the  distribution  of  tuberculosis  in  the  human 
species.  Although  the  number  of  persons  dying 
of  consumption  is  frightfully  large,  the  number  of 
tubercular,  and  tubercularly  infected,  persons  is 
much  larger.  Not  until  recent  years  have  we  secured 
tolerably  reliable  data  to  enable  us  to  judge  of  the 
distribution  of  tuberculosis  in  civilized  countries. 

If  we  classify  as  tuberculous  every  case  in  which 
there  are  pathological  changes  due  to  tubercle 
bacilH,  then  surely  the  oft-quoted  saying  of  the 
noted  Greifswald  physician  is  true,  "We  are  all  a 
bit  tuberculous."  It  has  not  been  easy  to  demon- 
strate this  fact  scientifically,  and  it  would  have 
been  impossible  of  demonstration  without  the  two 
epoch-making  discoveries  of  Robert  Koch,  that  of 
tubercle  bacilli,  and  of  tuberculin. 

Not  even  a  man  of  the  scientific  attainments  of 


THE   C ASSEL    LECTURE.  17 

Virchow  was  able  to  judge  what  constitutes  tuber- 
culosis, although  during  fifty  years  he  had  endeavored 
to  formulate  data  for  the  differential  diagnosis  of 
post-mortem  findings.  Since  we  have  learned  that 
Koch's  bacillus  is  the  bond  of  union  between  all 
the  various  tubercular  diseases,  we  see  that  many 
inflammatory  processes  which  Virchow  described 
as  entirely  distinct  and  different  are  nothing  else 
than  special  stages  in  the  tubercular  infection. 
The  anatomical  unit  of  the  tubercular  process  is 
the  tiny,  translucent  gray  nodule  of  millet-seed  size 
described  by  Laennec  and  Virchow,  the  miliary 
tubercle.  But  what  may  develop  from  this  may  take 
the  form  of  most  widely  divergent  pathological 
lesions,  and  it  was  not  granted  to  Virchow  to  puzzle 
out  the  endless  variety  of  things  etiologically  the 
same.  Yet  it  is  etiologically  that  the  vital  processes 
must  be  analyzed  if  we  wish  to  have  a  firm  basis 
for  our  struggle  against  preventable  diseases.  This 
has  more  and  more  become  the  opinion  of  modern 
physicians.  The  progress  that  has  been  made, 
first  in  surgery  and  then  in  internal  medicine, 
progress  that  only  fifty  years  ago  was  declared 
by  the  most  eminent  representatives  of  medicine 
in  those  days  to  be  impossible,  has  been  possible 
only  through  the  etiological  investigations  devel- 
oped by  Pasteur  and  by  Koch. 

The  first  principle  in  the  etiological  investigation 
of  all  vital  processes,  and  therefore  of  those  con- 
cerned   in    infectious    diseases    caused    by    micro- 


l8  THE  SUPPRESSION   OF    TUBERCULOSIS. 

organisms,  is  thus  formulated  by  Darwin:  "That 
which  is  of  the  same  origin  belongs  to  the  same 
species."  Two  infectious  agents  may  resemble 
each  other  ever  so  closely,  but  if  they  have  not 
the  same  genealogy,  i.e.,  if  they  are  phylogenetically 
widely  separated,  then,  biologically,  they  belong  to 
different  species.  And  conversely,  size,  form,  and 
other  properties  of  certain  micro-organisms  may  be 
ever  so  different.  If,  however,  the  organisms  are  of 
the  same  origin,  then,  biologically,  they  belong  to 
the  same  species.  The  virus  of  anthrax  occurs 
in  two  forms:  as  bacilli,  and  as  oval  spores.  The 
quotidian  malaria  parasite  has  an  extraordinarily 
complicated  cycle  of  development.  Nevertheless 
we  have  no  hesitancy  in  speaking  of  either  an 
anthrax  virus  or  of  a  malaria  parasite.^ 

The  virus  of  human  tuberculosis,  the  tubercle 
bacillus  of  Koch,  possesses  narrowly  limited  mor- 
phological characteristics.  It  is  readily  recognized 
since  Koch  published  his  very  accurate  descrip- 
tion of  it  in  1882,  and  especially  since  Ehrlich, 
shortly  afterward,  published  a  specific  staining 
procedure.  The  tubercle  bacilli  are  familiar  to  us 
as  rods  of  varying  length,  but  of  fairly  constant 
thickness,  which  occasionally  show  granular  degen- 
eration.    I  believe  it  is  now  ever3rwhere  accepted 


^  On  the  other  hand,  certain  stages  in  the  development  of  various 
malaria  parasites  resemble  each  other  very  closely  ;  but  we  distinguish 
the  parasites  definitely  because  they  are  of  different  origin, 


THE  C ASSEL  LECTURE.  1 9 

that  the  presence  of  these  bacilH  in  a  lesion  in  the 
human  body  indicates  the  tubercular  character  of 
that  lesion.  Leprous  lesions  with  somewhat  similar 
bacilli  must,  of  course,  be  taken  into  account,  but 
these,  as  a  rule,  can  already  be  differentiated 
macroscopically. 

Recognizing  this  significance  of  the  presence 
of  Koch's  bacilli  and  applying  all  other  known 
methods  for  the  identification  of  tuberculosis, 
Dr.  Naegeli  of  Zürich,  working  under  the  direction 
of  Prof.  Ribbert,  was  unable  to  discover  at  autopsy 
a  single  body  over  thirty  years  old  in  which  there 
were  not  some  signs  of  the  occurrence  of  a  tuber- 
cular infection.  Between  the  ages  of  i8  and  30 
there  were  96%;  between  14  and  18,  50%;  between 
5  and  14,  33%;  and  between  i  and  5  years,  17%, 
which  showed  the  presence  of  tubercular  lesions.  In 
the  bodies  of  infants  under  one  year,  on  the  other 
hand,  definite  tubercular  signs  wxre  invariably  absent. 

The  astonishing  results  of  these  careful  anatomical 
investigations  have  been  verified  by  reports  from 
pathological  anatomists  in  other  cities;  yet  at  first 
sight,  they  seem  to  contradict  all  medical  and 
other  experience,  for  according  to  these  results 
all  of  us  assembled  in  this  hall  are  tuberculous! 
But  the  perfected  diagnosis  of  tuberculosis  in  the 
living  person  leaves  no  doubt  that  Naegeli 's  figures, 
at  least  for  thickly  populated  centers,  possess 
general  applicability.  To  be  sure,  if  we  count 
only    the    patients    who    come    to    the    physician 


20  THE   SUPPRESSION   OF    TUBERCULOSIS. 

because  of  tubercular  or  supposedly  tubercular 
symptoms,  then  our  figures  do  not  agree  with 
Naegeli's;  nor  will  the  statistics  of  living  persons 
in  whom  we  can  discover  tubercle  bacilli  agree 
with  the  autopsy  statistics.  The  agreement,  how- 
ever, becomes  very  close  if  we  make  use  of  a  diag- 
nostic method  furnished  us  by  the  second  of  Koch's 
above-mentioned  discoveries, the  tuberculin  injection. 

Koch's  tuberculin  is  a  water-soluble  tubercular 
toxin,  given  off  from  the  bodies  of  the  tubercle 
bacilli  to  the  culture  medium,  and  concentrated 
together  with  glycerine.  Injected  either  subcu- 
taneously  or  intravenously  it  causes  no  reaction 
in  persons  free  from  tubercular  infection.  On 
the  other  hand,  it  is  one  of  the  strongest  poisons 
for  those  who  are  under  the  influence  of  such 
an  infection.  Even  before  the  infection  has  led  to 
clearly  recognizable  lesions,  and  long  before  there 
are  any  symptoms  of  tubercular  disease,  and  even 
if  the  most  careful  physical  examination  fails  to 
discover  a  suspicion  of  tuberculosis  during  the 
entire  lifetime  of  the  individual,  his  peculiar  sus- 
ceptibility to  this  tuberculin  injection  shows  that 
somewhere  in  his  tissues  or  body  fluids  tubercle 
baccilli  are  producing  their  peculiar  changes. 

The  nature  of  these  changes  is  becoming  scme- 
what  clear  to  us  since  there  have  been  discovered 
in  the  extra-vascular  blood  of  tubercularly  infected 
men  and  animals  coagulation  and  agglutination 
phenoinena  which  are  entirely  absent  in  the  blood, 


THE  CASS  EL   LECTURE.  21 

of  non-infected   individuals.     It   axjpears   that   the 
activities    of   the    tubercle   bacilli   in    the   body   of 
the  host  excite  the  production   of  a  soluble  anti- 
body.      When    this    anti-body    comes    into  contact 
with  the  water-soluble  substances  derived  from  the 
tubercle  bacilli,  Koch's  tuberculin,  it  is  transformed 
into    an    insoluble    body.     According    to    my    own 
researches    I    believe    it    probable    that    this    anti- 
body is   formed   by   the   smallest   arterioles   in  the 
neighborhood  of  the  infected  area.     The  extent  of 
the   agglutination   phenomena   varies   according  to 
the  amount  of  anti-body  and  of  the  tuberculin  with 
which  it  comes  into  contact.     This  manifests  itself 
clinically,  by  the  degree  of  fever,  and  anatomically, 
by  intravascular  coagulations.     The  latter,  in  some 
cases    may    lead    to    exudations    or   to    the    escape 
of  blood  from  the  pathologically  altered  vessels.     As 
a  result  of  the  tubercular  poisoning,  we  would  then 
have,  at  autopsy,  the  typical  picture  of  a  tuberculin 
reaction. 

Tuberculin,  in  its  action  as  a  blood  poison  for  an 
individual  infected  with  tuberculosis,  behaves  like 
many  other  infectious  poisons.  Very  small  fractions 
of  the  cm")unt  sufficient  to  threaten  life  cause  a 
distinct  reaction.  This  is  manifested  by  a  rise  of 
temperature  preceded  by  a  sharp  fall.  I  know, 
through  personal  experience,  of  a  case  of  human 
tuberculosis  in  which  more  than  a  hundred  times 
the  usual  diagnostic  dose  of  tuberculin  was  admin- 
istered.    But  aside  from  several  days  of  high  fever 


22  TBE  SUPPRESSION   OF   TUBERCULOSIS. 

and  a  considerable  feeling  of  illness,  it  had  no 
damaging  influence  on  the  patient's  general  condi- 
tion. Koch,  the  discoverer  of  tuberculin,  once  took 
a  strong  dose  of  tubercular  poison  in  the  form 
of  dead  tubercle  bacilli  and  became  very  ill.  In 
his  case  probably  a  hundredth  of  the  amount 
would  have  sufficed  to  cause  transient  temperature 
changes  and  thus  have  demonstrated  that  he  also 
had  once  been  infected  with  tubercle  bacilli.  Ten 
years  ago  I  myself  reacted  to  a  dose  of  4  mg.  with 
fever  and  a  pronounced  feeling  of  illness  which 
confined  me  to  my  bed  for  several  days  in  San  Remo. 
Therefore  I  have  no  doubt  about  the  tubercular 
infection  of  my  body. 

The  most  instructive  evidence  to  confirm  the 
general  truth  of  Naegeli's  figures  is  furnished  by  the 
results  of  investigations  made  by  the  Austrian  army 
surgeon.  Dr.  Franz,  on  soldiers  of  two  regiments  of 
infantry.  In  order  to  avoid  injuring  the  health  of 
the  individuals  tested,  Franz  used  only  very  small 
doses  of  tuberculin,  i  to  3  mg.,  which,  in  case  the 
injection  was  repeated,  was  increased  to  5  mg.  In 
spite  of  this,  and  in  spite  of  the  fact  that  the  soldiers 
represented  the  healthiest  individuals  of  the  popula- 
tion, he  found  in  one  regiment  in  the  first  year  of 
service  (1901)  61%,  and  in  the  second  year  of 
service  68%  of  tubercularly  infected  cases.  Franz 
adds  to  his  report,  which  at  present  I  have  only  in 
manuscript,  that  when  he  employed  the  dose 
originally    recommended    by    Koch,    namely    one 


THE   C ASSEL   LECTURE.  2$ 

centigram,  his  percentage  for  the  twenty-first  year 
of  life  approached  Naegeli's  very  closely,  96%! 

On  the  other  hand  the  Hungarian  investigator 
Dr.  Nikolaus  Berend  has  not  obtained  a  single 
positive  tuberculin  reaction  in  ninety-six  very 
young  children,  in  spite  of  the  fact  that  among 
these  were  some  very  feeble  individuals,  and 
children  of  parents  manifestly  tubercular;  and 
further,  despite  doses  as  high  as  i  eg.  We  see 
then  that  herein  also  the  statistics  coincide  with 
Naegeli's  post-mortem  statistics. 

Another  proof  that  human  tuberculosis  is  much 
more  widely  disseminated  than  was  heretofore 
believed  is  furnished  us  by  a  diagnostic  method 
devised  by  the  French  clinician  Andre  Jousset, 
namely  ''inoscopy."  By  means  of  inoscopy  we 
can  examine  microscopically,  for  tubercle  bacilli, 
coagulable  inflammatory  exudates  and  the  blood 
of  suspected  cases  of  tuberculosis,  even  though  only 
very  few  bacilli  are  distributed  in  large  amounts  of 
fluid.  And  we  examine  these  fluids  directly,  not 
indirectly  by  means  of  cultures.  As  a  result  of  the 
coagulation  the  bacilli  are  fixed  by  the  fibrin, 
from  which  they  are  freed  by  dissolving  the  fibrin 
with  an  appropriate  digesting  fluid.*     The  bacilli 


^  Formula  for  the  digesting  fluid: 

Pepsin 1-2  gm. 

Glycerin 10  c.c. 

HCl  22°  Baume ,  10  c.c. 

Sodium  fluorid 3  gm. 

Distilled  water 1000  c.c. 


24  THE  SUPPRESSION   OF   TUBERCULOSIS. 

are  then  separated  by  centrifuge  and  can  be  exam- 
ined directly  in  microscopical  preparations.  With, 
the  aid  of  this  very  valuable  diagnostic  method  we 
are  enabled  to  demonstrate  the  tubercular  origin  of 
almost  all  serous  pleurisies,  of  many  exudative 
peritonites,  of  accumulations  of  fluid  in  the  peri- 
toneal cavity  of  alcoholic  individuals  with  liver 
cirrhosis,  of  joint  inflammations,  of  exudative 
meningites,  of  many  cases  of  heart-disease  and  of 
other  classes  of  symptomatic  affections,  where 
formerly  most  physicians  did  not  think  of  the  pos- 
sibility of  these  affections  being  tubercular. 

I  cannot  fail  to  express  my  conviction  of  the 
general  diffusion  of  tuberculosis  in  densely  crowded 
populations,  and  of  the  consequent  futility  of 
all  attempts  to  suppress  the  disease  by  means 
of  isolation  and  segregation.  What  would  be  the 
outcome  if  we  were  to  adopt  the  suggestion  seriously 
put  forth,  to  send  all  the  tubercularly  infected 
soldiers  to  hospitals,  later  discharging  them  as 
unfit  for  service?  We  should  not  have  more 
than  5%  left  for  active  service,  and  even  this 
small  number  would  probably  after  the  lapse  of  a 
few  years  be  declared  tuberculous.  At  the  most 
I  can  assent  only  to  the  separation  of  the  coughing 
consumptive  from  the  apparently  healthy  individual ; 
and  these  should  be  sent,  not  to  sanitaria  [Heil- 
stätten], but  to  homestead  colonies  [Heimstätten] 
such  as  we  formerly  maintained  for  lepers. 

We  need  not,  however,  idly  fold  our  hands  and 


THE   CASS  EL   LECTURE.  25 

become  fatalists  who  see  the  inevitable  destruction 
of    the    human    race    by    tuberculosis.     Tubercular 
infection  does  not  by  any  means  signify  tubercular 
consumption.     It    is    just    this    enormous    diffusion 
of  tubercular  infection  which  demonstrates,  better 
than  anything  else,  the  curability  of  many  tuber- 
cular  diseases,    their   liability   to   spontaneous   cure; 
for  I  must  admit  that   I  have  little  faith  in  the 
curative  action   of  any  of  the  numerous  methods 
of    treating    tuberculosis.     Here    also    the    maxim 
formerly  applied  to  diphtheria  holds  true,   "mild 
cases    go    on    to    recovery,    severe    infections    are 
fatal ' ' ;  and  here  as  in  diphtheria  I  was  confronted 
by  the  question  whether  there  are  ways  and  means 
to  prevent  severe  infections  with  bad  prognoses,  or 
to  convert   severe   infections   into  mild   ones  with 
favorable  prognoses.     You  will  be  able  to  answer 
this  question  yourself  if  I  now  give  you  the  results 
of  my  experimental  investigations  on  the  occurrence 
and  prevention  of  tubercular  consumption.     I  shall 
begin  by  discussing  the  requirements  necessary  for 
the  development  of  tubercular  consumption  in  man. 
But  first   of  all   I  must  say  that  according  to 
my   ideas   there   has   not   yet   been   a   single  well- 
authenticated  case  in  which  pulmonary  consump- 
tion has  originated  in  adult  persons  as  the  result 
of  a  tubercular  infection  developing  epidemiologic- 
ally,   i.e.,    under   essential   conditions   for  infection 
occurring   in   nature.     Even   coimting   those   cases 
in  which  mortuary  assistants,  butchers,  and  labora- 


20  THE  SUPPRESSION  OF   TUBERCULOSIS. 

tory  workers  have  been  severely  infected  through 
the  subcutaneous  tissues,  I  still  fail  to  find  any 
proof  that  a  traumatic  infection  has  caused  pul- 
monary consumption  in  an  individual  not  yet 
infected  with  tubercle  bacilli. 

I  am  well  acquainted  with  the  argument  by 
which  it  is  sought  to  prove  that  pulmonary  con- 
sumption may  develop  as  a  result  of  inspiration 
of  particles  of  dust  or  moisture  containing  tubercle 
bacilli.  The  facts  on  which  this  argument  is  based 
are  the  greater  occurrence  of  tuberculosis  and  a 
higher  mortality  rate  from  that  disease  among 
nurses,  occupants  of  houses  in  which  there  are  pro- 
nounced cases  of  phthisis,  among  the  inmates  of 
prisons,  etc.  But,  considering  the  figures  pre- 
viously given,  showing  the  enormous  diffusion  of 
tuberculosis,  the  objection  is  surely  justified  that 
the  persons  thus  dying  of  consumption  already 
had  a  tubercular  focus  in  the  lungs  and  that  this 
pulmonary  disease,  under  a  mode  of  life  favorable 
to  tuberculosis,  was  converted  into  florid  phthisis. 

In  order  not  to  be  misunderstood,  I  wish  to  em- 
phasize here  that  I  do  not  at  all  deny  that  infection 
can  be  caused  in  adults  by  inoculation  with  tuber- 
cular virus.  In  fact,  I  assume  that  few  of  us  in 
advanced  life  escape  such  infection.  But  that  this 
infection  leads  to  cavity  formation  in  the  lungs, 
is,  I  believe,  fully  as  unproved  as  the  assertion 
that  bovine  tubercular  virus  has  caused  human 
pulmonary  consumption  in  even  a  single  instance. 


THE  CASS  EL  LECTURE.  27 

Koch  has  very  properly  pointed  out  the  entire 
absence  of  proof  for  this  last  statement.  I  can 
go  still  further  in  my  concessions  to  the  prevalent 
view  that  consumption  results  from  the  inhalation 
of  particles  of  dust  or  moisture  laden  with  tubercle 
bacilli.  I  concede  not  only  the  possibility  but 
the  actual  occurrence  of  pulmonary  tuberculosis 
going  on  to  consumption,  as  a  result  of  infection 
of  an  adult  person.  I  concede  this  in  the  sense 
that  on  the  basis  of  an  infantile  infection  a  pul- 
monary tuberculosis  has  developed  which  becomes 
manifest  only  through  the  agency  of  the  additional 
infection..  However,  the  opportunity  for  infection 
with  tubercle  bacilli  cannot  by  itself  be  a  deciding 
factor  in  the  development  of  pulmonary  consump- 
tion. I  can  here  cite  the  experience  of  Dr.  Moritz 
Schmidt  of  Frankfurt  a.  M.,  who  has  examined  a 
great  number  of  cases  of  tubercular  laryngitis. 
In  his  experience  of  over  forty  years  he  has  cer- 
tainly been  exposed,  more  than  others,  to  tuber- 
cular infection.  But  neither  he  nor  any  of  his 
numerous  assistants  has  ever  become  consumptive. 
My  experiments  on  animals  have  shown  me  that 
the  lesions  characteristic  of  human  pulmonary 
consumption  are  developed  only  after  there  have 
been  extensive  and  long-continued  disturbances 
of  the  vital  functions  of  the  organism.  Our  an- 
cestors introduced  the  term  ''dyscrasia"  and  "dis- 
eased constitution"  to  express  this  idea.  I  have 
succeeded,    especially   in   goats,    but   also   in  other 


2S  THE  SUPPRESSION   OF   TUBERCULOSIS. 

animals,    in    producing    a    clinical    picture    exactly 
similar  to  that  of  human  pulmonary  consumption. 
In  these  animals  I  first  produced  a  moderate  degree 
of    immunity    against    tuberculosis    by    a    lengthy 
course  of  treatment,  and  then  I  injected  a  strong 
tubercular    virus    into    the    circulation.     I    regard 
the    lesions    in    pulmonary    consumption    as    being 
produced    in    similar    fashion.     They    are    the    ex- 
pression of  an  infection  in  an  individual  who,  owing 
to   a   very  early  previous   infection  with  tubercle 
bacilli,    is    less    susceptible    to    the    new    infection. 
These    late    infections    may    in    isolated    cases    be 
referable  to  the  inhalation  of  tubercle  bacilli.     They 
may,  however,  be  due  to  already  existing  tuber- 
cular lesions,  and  so  be  regarded  as  auto-infections 
or  metastases.     Were  we   to   inject   into    the   tissue 
juices  of  a  person  not  yet  partially  immunized  against 
tuberculosis  an   amount   of  tubercle   bacilli  equal   to 
that  usually  found  in  the  lungs  of  consumptives,  the 
person  would  die  of  an  acute  miliary   tuberculosis^ 
hut  he  would  never  develop  pulmonary  consumption. 
There  is  another  argument  against  the  common 
assumption  that  primary  infection  by  way  of  the 
respiratory   organs    is    the    cause    of   consumption, 
and  this  is  furnished  by  an  analysis  of  the  ana- 
tomical findings.     If  we  allow  an  individual,  entirely 
free  from  tuberculosis,  to  breathe  tubercle  bacilli, 
the  opportunity  for  an  intestinal^  infection  is  surely 

*  The  intestine  reckoned  from  the  pharynx  down  through  the  stomach 
to  the  rectum.     See  appendix,  p.  8i. — Translator. 


THE  CASS  EL  LECTURE.  29 

presented ;  on  the  other  hand,  that  any  bacilli  what- 
ever reach  the  lungs  directly  cannot  be  positively 
affirmed.  Infection  of  the  organs  of  the  pharynx  and 
larynx  in  these  cases  always  corresponds  to  disease 
of  the  lymph-vessels  and  glands  in  the  neck,  and 
gives  the  individual  the  scrofulous  habitus.  Now 
let  us  recall  the  neck  of  consumptives.  It  appears 
almost  as  if,  at  the  time  when  an  individual  may 
be  designated  as  being  a  candidate  for  consumption, 
the  organs  of  the  neck  were  already  quite  immune 
against  a  vulgar  tubercular  infection. 

I  could  multiply  the  arguments  in  favor  of  my 
assertion  that,  in  order  to  have  pulmonary  con- 
sumption follow  infection  with  inspired  tubercle 
bacilli,  it  is  necessary  to  have  constitutional  changes 
in  the  organism  due  to  an  early  previous  infection. 
I  hope,  however,  to  have  sufficiently  established 
my  reasons  for  rejecting  the  current  theory  of  the 
origin  of  consumption,  a  theory  due  mainly  to  the 
valuable  and  detailed  researches  of  Cornet. 

I  must  decline  to  accept  another  wide-spread 
view,  namely,  that  hereditary  influences  are  de- 
ciding factors.  Theoretically  an  intra-uterine  in- 
fection with  tuberculosis  is  certainly  possible,  and 
in  a  few  cases  such  an  infection  has  actually  been 
proven.  But  neither  the  parental  nor  the  pre- 
parental  transmission  of  tubercle  bacilli,  nor  the 
hypothetical  transmission  of  a  body  predisposition  to 
tuberculosis,  is  of  any  practical  importance.  Never- 
theless, according  to  my  researches,  the  view  preva- 


so  THE  SUPPRESSION   OF   TUBERCULOSIS. 

lent  among  the  laity  regarding  the  important  influ- 
ence of  parents,  grandparents,  and  other  near  rela- 
tives, in  the  etiology  of  consumption,  is  entirely 
justified  and  proper.  I,  too,  am  of  the  opinion  that 
one  can  properly  speak  of  the  bad  prognosis  in  cases 
of  family  tuberculosis.  If,  in  taking  the  history  of 
a  patient,  I  should  elicit  the  fact  that  several  near 
relatives  had  died  of  consumption,  and  if,  then,  by 
means  of  the  tuberculin  reaction  or  of  inoscopy,  I 
made  the  clinical  diagnosis  of  a  tubercular  in- 
fection, I  should  be  very  pessimistic  in  my  prog- 
nosis, even  though  the  infection  were  not  other- 
wise manifest. 

I  may  very  properly  be  asked  how  I  can  deny 
hereditary  transmission  and  yet  place  so  high  a 
rating  on  the  influence  of  the  ancestors,  cognates, 
and  house-fellows,  in  the  production  of  pulmonary 
consumption.  A  little  explanation  regarding  the 
meaning  of  certain  terms  will  make  my  ideas  per- 
fectly clear 

The  expression  hereditary  transmission  of  tuber- 
culosis, or  rather,  of  tubercle  bacilli,  may  be  con- 
strued in  several  different  ways.  It  may  mean  the 
hereditary  transmission  from  father  or  mother,  or 
from  grandfather  or  grandmother,  or  from  an- 
cestors still  further  back.  If  we  designate  the 
parental  transmission  as  congenital  heredity,  trans- 
mission from  further  back  as  pregenital  heredity, 
then  in  my  view  of  the  origin  of  pulmonary  con- 
sumption,   generally    neither    congenital    nor    pre- 


THE   CASS  EL  LECTURE.  3 1 

genital  heredity  comes  into  play.  And,  looking 
at  the  matter  as  I  do,  if  one  is  still  desirous  of 
speaking  of  the  hereditary  influences  of  relatives, 
one  ought  to  use  the  term  postgenital.  It  is  now 
almost  everywhere  conceded  that  human  tubercu- 
losis as  a  rule  is  actually  of  postgenital  origin. 

Experience  has  taught  me  that  if,  in  scientific 
investigation,  one  wishes  to  discover  something 
new,  one  should  study  the  exceptions  to  the  rule. 
In  actual  practice,  on  the  other  hand,  it  is  well  to 
keep  to  the  rule.  We  may  therefore  safely  ignore 
the  cases  of  congenital  tuberculosis,  but  must  aU 
the  more  thoroughly  study  the  circumstances 
which  in  extra-uterine  life  govern  the  tubercular 
infections  which  lead  to  consumption.  And  here 
I  believe  I  have  discovered  a  new  principle  which 
may  be  expressed  thus: 

"  The  milk  fed  to  infants  is  the  chief  cause  of  con- 
sumption.'^ 

This  assertion  will  at  first  sight  be  surprising,  for 
it  has  long  been  maintained  that  the  suckling 
infant  receives  milk  free  or  almost  free  from  germs. 
Mother's  or  nurse's  milk  is  taken  by  the  child  in 
this  condition,  and  the  cow's  milk  for  artificially 
nourished  children  is  usually  first  boiled  or  scalded. 
In  later  life,  to  be  sure,  much  less  attention  is  paid 
to  securing  a  milk  as  sterile  as  possible.  How,  then, 
is  this  to  be  reconciled  with  the  above  statement, 
that  it  is  especially  the  milk  fed  to  infants  which 
constitutes  the  chief  danger  in  causing  tuberculosis? 


Z2  THE  SUPPRESSION   OF    TUBERCULOSIS. 

And  yet  this  statement  is  true,  not  because  the 
milk  fed  to  infants  is  at  all  worse  than  other  milk, 
but  because  the  human  infant,  like  the  young  of 
all  other  mammals,  is  destitute  of  the  protective 
agencies  in  his  alimentary  system  which  at  a  later 
period  of  life  prevent  the  entrance  of  disease  germs 
into  his  tissues.  It  has  taken  many  years  of  ex- 
perimental work  to  demonstrate  this  fact  con- 
clusively. At  present,  however,  the  chain  of  evi- 
dence is  so  strong  that  I  have  not  the  least  hesi- 
tancy in  building  on  it  my  entire  plan  for  the  sup- 
pression of  tuberculosis. 

In  this  lecture  I  can  do  no  more  than  summarize 
the  main  proofs  for  my  assertion  regarding  the  ready 
penetrability  of  the  infantile  alimentary  tract  for  all 
disease  germs,  but  especially  for  tubercle  bacilli. 

I  began  with  a  very  interesting  fact  discovered 
by  my  fellow-worker.  Dr.  Römer.  He  showed 
that  true  albumins  penetrate  unchanged  the  in- 
testinal mucous  membrane  of  new-born  foals, 
calves,  and  smaller  laboratory  animals,  and  that 
they  produce  the  same  action  on  the  organism  as 
when  they  are  injected  directly  into  the  circulation. 
In  adult  animals  of  all  species,  on  the  contrary,  the 
true  albumins  must  first  be  digested  into  peptones 
before  they  can  pass  through  the  mucous  mem- 
brane. The  anti-diphtheria  serum  and  the  anti- 
tetanus serum  contain  curative  substances  in  the 
form  of  true  albumins.  If  such  a  serum  be  in- 
troduced into  the  stomach  of  a  healthy,  full-grown 


THE   C ASSEL    LECTURE.  33 

animal  or  man,  not  a  trace  of  these  bodies  passes 
into  the  blood.  On  introducing  the  serum,  liow- 
ever,  into  the  stomach  of  the  new-born,  the  un- 
changed antitoxic  albumin  can  almost  entirely 
be  demonstrated  in  the  blood.  This  discovery 
indicates  that  the  mucous  membrane  of  adults, 
acting  as  a  dialyzing  membrane,  does  not  allow 
the  large  molecules  of  true  albumins  to  pass  through 
unchanged,  whereas  the  mucous  membrane  of 
suckHngs  behaves  more  like  a  very  porous 
filter. 

It  was  but  a  step  from  this  discovery  to  the 
assumption  that  the  mucous  membrane  of  infants 
might  behave  similarly  toward  bacteria.  For  my 
first  experiments  I  selected  anthrax  bacilh,  which, 
when  free  from  spores  and  given  in  milk  per  stomach, 
do  not  affect  adult  guinea  pigs  at  all.  They  are 
quite  rapidly  thrown  off  with  the  excreta,  re- 
maining, however,  a  little  longer  in  the  caecum. 
When  the  same  dose  of  bacilh  was  administered 
in  this  way  to  guinea-pigs  less  than  eight  days  old, 
they  died  just  as  rapidly  of  anthrax  as  by  the  cus- 
tomary method  of  infection.  Next  I  tried  anthrax 
bacilli  whose  virulence  had  been  reduced.  These 
are  harmless  when  injected  subcutaneously  into 
guinea-pigs.  After  feeding  these  weakened  bacilli 
to.  new-horn  guinea-pigs,  the  blood  of  the  animals 
contained  anthrax  bacilli,  though  the  animals  did  not 
die.  Incidentally,  a  fact  of  considerable  theoretical 
importance  was  discovered:  that   the  anthrax  bacilli 


34  THE  SUPPRESSION   OF   TUBERCULOSIS, 

possess  a  very  intimate  affinity  for  the  endothelium  of 
the  heart  and  blood  vessels. 

Having  thus  studied  the  fate  of  anthrax  bacilli 
introduced  into  the  stomach  of  new -bom  and  adult 
guinea-pigs,  1  now  turned  to  a  similar  study  of 
tubercle  bacilli.  Together  with  Dr.  Römer  I 
studied  the  behavior  of  guinea-pigs  toward  a  defi- 
nitely weighed  quantity  of  tubercle  bacilli  given  in 
one  single  feeding.  And  here  also,  as  in  the  case 
of  anthrax  bacilli,  it  was  found  that  when  the 
tubercle  bacilli  could  be  demonstrated  microscopi- 
cally nowhere  else  in  the  alimentary  tract,  they  were 
often  present  in  the  caecum.  After  a  single  feeding 
of  a  small  quantity  of  tubercle  bacilli,  only  the 
new-bom  or  the  few-days-old  guinea-pigs  became 
tuberculous.  When  larger  doses  were  administered 
it  happened  that  older  animals  also  became  tuber- 
culous. At  the  post-mortem  examination  of  the 
new-bom,  a  few  days  later,  there  were  found 
sub-miliary  thickenings,  with  tubercle  bacilli  in 
the  great  and  the  lesser  omentum.  There  were 
also  little  nodules  at  a  point  on  the  root  of  the 
raesentery,  not  far  from  the  caecum.  Of  especial 
interest  is  the  further  development  of  this  alimentary 
tuberculosis  in  the  guinea-pigs  which  survived. 
In  these  animals,  even  while  their  general  health 
remains  good,  it  is  always  possible  to  demonstrate 
a  tuberculosis  of  the  glands  of  the  neck,  a  type 
of  disease  which  may  be  said  to  correspond  to  scrof- 
ula in  man.     Not   infrequently   there   is   later   on 


TUE   CASSEL   LECTURE,  35 

developed  that  type  of  guinea-pig  tuberculosis 
which  has  heretofore  been  regarded  as  the  expres- 
sion of  an  inhalation  tuberculosis. 

In  the  results  of  all  these  investigations  I  see 
experimental  support  for  the  view  I  have  for  some 
time  maintained,  namely,  that  the  origin  of  the 
epidemiological  pulmonary  tuberculosis  in  man 
and  that  of  the  epizootic  pulmonary  tuberculosis 
in  cattle  is  a  primary  intestinal  infection  occurring 
in  very  early  infancy.  In  this  I  leave  tmdecided 
whether  the  bacilli  gain  access  to  the  body  through 
feeding  or  through  inspiration. 

Upon  reflection  it  will  at  once  be  seen  that 
from  these  experimental  data  showing  the  ready 
penetrability  of  the  infantile  mucous  membrane, 
another  logical  deduction  follows:  If  even  non- 
virulent  anthrax  bacilli  introduced  per  stomach 
gain  ready  access  to  the  circulation  of  the  new- 
bom,  then  it  must  be  possible  for  all  the  bacteria 
of  milk  to  do  the  same,  and  we  may  therefore 
expect  that  the  accidental  presence  of  pathogenic 
bacteria  in  the  milk  fed  to  infants  will  exercise  a 
damaging  influence  on  the  infant  organism.  In 
considering  their  pathogenic  possibilities  the 
amoimt  of  the  infectious  germs  which  enter  the 
system  must,  of  course,  be  a  matter  of  some  impor- 
tance. Under  certain  conditions,  however,  even  a 
few  germs  may  be  sufficient  to  excite  disease, 
for  in  the  intestines,  especially  in  the  c^cum, 
they  find  an  excellent  place  of  incubation  where 


36  THE  SUPPRESSION   OF   TUBERCULOSIS. 

they  can  multiply.  A  milk  very  poor  in  disease 
germs  may  thus  lead  to  a  virulent  infection.  In 
breast-fed  infants  the  danger  of  introducing  disease 
germs,  excepting  tubercle  bacilli,  of  which  I  shall 
speak  later,  is  not  very  great,  for  it  is  very  unusual 
for  living  germs  derived  from  the  interior  of  the 
body  to  appear  in  the  milk.  The  germs  which 
can  be  found,  even  in  perfectly  fresh  milk,  are 
derived  from  the  surface  of  the  body,  or  from 
the  mouths  of  the  lacteals,  or  possibly  even  from 
the  glandular  epithelium,  as  researches  conducted 
by  myself,  assisted  by  Mr.  Rosier,  have  shown. 

But  in  artificially  nourished  infants  the  matter  is 
altogether  different.  It  would  be  a  miracle  if, 
after  all  the  manipulations  to  which  the  milk 
supplied  to  our  large  cities  is  subjected,  it  did 
not  occasionally  contain  disease  germs  derived 
from  the  milker  or  from  other  persons  who  have 
handled  the  milk. 

If,  by  the  time  the  milk  reaches  the  city,  the 
proliferation  of  these  pathogenic  micro-organisms 
has  already  gone  on  to  a  considerable  extent, 
then  usually  the  milk  will  contain  a  number  of 
poisonous  substances  in  addition  to  the  micro- 
organisms. Some  of  these  germs  are  killed  by 
•the  scalding  to  which  the  milk  is  usually  subjected 
before  feeding,  and  the  virulence  of  the  rest  is 
much  diminished,  so  that  in  boiled  milk  practically 
no  danger  is  to  be  apprehended  from  the  micro- 
organisms.    We    are    not    at    all    sure,    however, 


THE   CASSEL   LECTURE.  37 

that  we  have  made  the  toxins  innocuous  by  this 
boihng,  and  probably  a  great  many  cases  of  intes- 
tinal catarrh  in  artificially  nourished  children  are 
due,  not  to  a  parasitic,  but  to  a  toxic  infection. 

I  said  it  would  be  a  miracle  if  artificially  nourished 
infants  did  not  frequently  suffer  from  milk  infec- 
tions, and  I  can  add  that  this  miracle  does  not, 
in  fact,  occur.  One  need  only  glance  at  the  mor- 
tality statistics  of  artificially  nourished  infants  in 
order  to  realize  that  my  experimental  results 
absolutely  agree  with  the  facts.  The  following 
figures  are  taken  from  the  excellent  report,  "  Gesund- 
heitswesen des  preussischen  Staates  im  Jahre  1901,'* 
which  has  recently  been  published  by  the  Prussian 
government. 

In  the  city  of  Stettin,  the  mortality  for  the  first 
year  of  life  was  473.52  for  every  1000  living  chil- 
dren of  the  same  age;  whereas  in  the  period  of 
10  to  15  years  the  mortality  was  2.94  to  each  1000 
living  children  of  that  age.  In  other  words,  during 
the  same  length  of  time  161  times  as  many  infants 
up  to  one  year  died  as  did  children  over  ten  years. 

Berlin,  with  a  mortality  of  286.29V00  fo^  "the 
first  year  of  life,  stands  about  midway  in  the  Hst 
of  Prussian  cities  having  over  100,000  population. 
Cassel,  with  183.54V00,  shows  about  the  lowest 
figure,  and  even  this  is  inordinately  high,  for  it  is 
not  in  the  nature  of  things  that  this  is  so.  We  are 
not  facing  a  necessity  of  nature  to  which  we  must 
submit  Hke  fatahsts.     This  can  be  readily  seen  by 


38  THE  SUPPRESSION  OF  TUBERCULOSIS. 

observing  that  there  are  towns  and  whole  regions 
in  which  the  mortahty  figures  for  the  first  year 
are  kept  within  moderate  limits.  In  Ireland  and 
Scotland,  as  well  as  in  Norway  and  Sweden,  the 
mortality  for  this  period  scarcely  exceeds  loVoo» 
about  one-fiftieth  the  mortality  in  Stettin.  In 
Stockholm  I  visited  a  fotmdling  asylum  with  an 
organization  bound  to  excite  admiration  and  wonder, 
in  which,  as  I  recollect,  the  mortality  was  still  less. 

Nowadays  the  assertion  that  the  character  of 
the  milk  fed  to  infants  is  responsible  for  the  great 
differences  in  the  mortality  statistics  is  nowhere 
seriously  questioned.  There  are,  however,  wide 
differences  of  opinion  as  to  what  the  determining 
factors  are,  and  how,  in  places  where  the  mortality 
figures  are  so  outrageously  high,  we  can  remedy 
the  evil. 

According  to  my  researches  into  this  subject 
this  problem  will  not  be  successfully  solved  by  the 
efforts  now  being  made  to  secure  the  use  of  sterilized 
milk.  I  am,  in  fact,  in  doubt  whether  milk  sterili- 
zation as  at  present  practised  can  much  longer  pass 
as  a  hygienic  measure.  For  the  present,  to  be 
sure,  we  have  nothing  better.  But  the  discussion 
of  this  question  does  not  fall  within  the  scope  of 
this  lecture.  I  have  quoted  the  statistics  of  the  high 
infant  mortality  in  our  large  cities  merely  in  order 
to  advance  a  further  epidemiological  argument  for 
my  assertion  that  the  infant  alimentary  tract  is 
defenseless  against  infectious  agents  whether  these 


THE  CASS  EL  LECTURE.  39 

are  living  or  not.  Even  the  infectious  toxins  pass 
unchanged  through  the  intestinal  mucous  membrane 
of  very  young  individuals,  though  not  through  that 
of  healthy  older  ones.  A  real  advance  in  milk 
hygiene  can,  however,  be  begim  even  now  if  the 
milk  be  pasteurized  at  the  dairies  and  not  at  the 
large  receiving-stations  in  the  cities.  In  the  raising 
of  calves,  this  procedure  has  proven  of  great  value. 

I  have  made  exhaustive  studies  to  discover  why 
the  intestinal  mucous  membrane  of  the  young 
should  offer  so  little  resistance  to  the  passage  of 
corpuscular  infectious  substances.  I  shall  content 
myself  here  with  the  statement  that  the  mucous 
membrane  of  new-bom  individuals  possesses  no 
continuous  epithelial  covering  and  that  the  gland- 
tubes  of  the  ferment-producing  glands  are  little, 
if  at  all,  developed  at  this  time. 

By  having  thus  presented  to  you  the  results  of 
my  experiments  and  explained  my  epidemiological 
views,  I  have  not  really  deviated  from  the  subject 
of  the  suppression  of  tuberculosis.  We  have  seen 
that  the  tubercle  bacilli  which  gain  access  to  the 
system  through  the  alimentary  tract  in  infancy 
constitute  the  important  etiological  factor  in  the 
production  of  the  tubercular  infection  which  leads 
to  consumption,  and  I  believe  that  the  realization 
of  this  great  fact  will  supply  us  with  a  rational 
plan  for  combating  tuberculosis.  It  will  be  neces- 
sary to  strive  more  than  ever  to  secure  a  suitable 
milk  diet  for  new-bom  and  very  young  children, 


40  THE  SUPPRESSION  OF   TUBERCULOSIS. 

one  based  on  sound  experimental  investigations. 
The  as  yet  unsolved  problem,  that  of  a  rational 
milk  hygiene  in  the  suppression  of  tuberculosis, 
coincides  with  the  problem  of  milk-feeding  of  in- 
fants in  general.  The  mode  of  infection  is  every- 
where the  same,  but  the  infectious  agents  are  of 
great  variety.  Most  of  them  excite  acute  diseases 
which  end  either  fatally  or  in  entire  recovery;  in 
the  latter  case  with  a  simultaneous  development 
of  immunity.  The  virus  of  tuberculosis,  however, 
behaves  quite  differently,  creeping  in  most  in- 
sidiously, all  unnoticed,  and  being  in  this  respect 
analogous  only  to  the  virus  of  leprosy,  of  syphilis, 
or  possibly  of  malaria  in  tropical  countries.  It 
may  be  months,  years,  or  decades  before  the  in- 
fection leads  to  manifest  disease.  This  depends 
on  the  virulence  of  the  virus,  which  is  generally 
much  greater  in  the  virus  of  bovine  tuberculosis 
than  in  that  of  human  tuberculosis.  It  also  de- 
pends on  the  number  of  bacilli  introduced  per 
stomach,  and  whether  such  introduction  is  single 
or  oft  repeated.  In  the  human  being  months  and 
years  may  elapse  before  the  infection  is  followed 
by  any  sensitiveness  to  tuberculin  injections  in  the 
usual  dose.  If,  then,  at  the  time  of  puberty,  or  after 
an  exhausting  puerperium,  after  too  great  a  demand 
on  the  milk  secretion  (especially  with  insufficient 
food),  after  so-called  colds  and  other  unfavorable 
meteorological  conditions,  after  muscular  over- 
exertion, under  conditions  unfavorable  to  life,  such 


THE   CA  SS  EL  LECTURE.  4 1 

as  improper  nourishment,  confinement  in  insuffi- 
ciently or  badly  ventilated  rooms,  etc.,  if,  after  any 
of  these,  pulmonary  disease  develops  whose  tuber- 
cular nature  we  cannot  doubt,  then  we  are  dealing 
with  the  beginning  of  consumption;  the  beginning 
of  tubercular  lesions  is  much  further  back;  and 
the  first  introduction  of  the  disease  germs,  in 
other  words,  the  beginning  of  the  infection,  is  far 
back  in  earliest  infancy.  This  must  be  so,  for  we 
see  many  individuals,  though  subject  to  the  most 
unfavorable  conditions,  for  example,  those  con- 
fined in  unsanitary  prisons,  wholly  escape  tuber- 
culosis. 

The  results  of  all  these  scientific  investigations 
lead  us  back  to  the  old  folk  belief  in  family  tuber- 
culosis and  hereditary  consumption,  with  this 
difference,  however,  that  now  we  believe  the  germs 
of  consumption  to  be  transmitted  postgenitally 
from  parents,  relatives,  or  house-companions.  If  a 
coughing  consumptive  lives  together  with  a  new- 
bom  child,  especially  if  cleanliness  leaves  much 
to  be  desired,  it  is  impossible  for  this  child  to 
avoid  infection  with  tubercle  bacilli.  They  are 
present  in  the  particles  of  sputum  which  are  scat- 
tered about  everywhere,  and  they  thus  gain  access 
to  the  mouth  and  nose  of  the  infant.  From  there 
they  reach  the  intestinal  mucous  membrane,  which 
they  penetrate,  and  so  they  invade  the  body  juices. 
Not  alone  infants,  but  older  persons  as  well,  are 
endangered  in  the  home  of  the  consumptive.     In 


42  THE  SUPPRESSION   OF    TUBERCULOSIS. 

these,  however,  there  must  previously  have  been 
pathological  changes  in  the  alimentary  tract,  or 
an  overwhelming  dose  of  the  infectious  agent,  in 
order  to  effect  an  intestinal  infection.  Patholog- 
ical changes,  accompanied  by  the  shedding  of  epi- 
thelium, occur  especially  in  the  exanthemata,  and 
particularly  after  measles.  The  laity  has  long 
noticed  this  close  relation  between  measles  and 
tuberculosis.  In  the  infant,  the  disposition  to 
intestinal  tubercular  infection  is  entirely  physio- 
logical and  normal.  The  healthiest  and  strongest 
infant  is  exposed  fully  as  much  as  the  weak,  sickly 
one,  and  perhaps  more  so,  for  in  the  latter  other 
parasites  are  contending  for  the  cells  on  which 
they  feed. 

I  have  now  given  you  a  general  idea  of  the  origin 
and  spread  of  the  tubercular  infections  ending 
disastrously.  This  brings  us  at  once  to  certain 
practical  points  in  dietetic  hygiene  which,  though 
never  entirely  neglected,  are  now  brought  into 
prominence. 

It  is  imnecessary  for  me  to  further  emphasize 
the  necessity,  in  infant  feeding,  to  insist  imder 
all  circumstances  on  milk  absolutely  free  from 
tubercle  bacilli;  nor,  what  is  equally  obvious,  that 
it  is  absolutely  necessary  to  keep  coughing  con- 
sumptives away  from  infants.  But  I  should  like 
to  observe  that  not  only  infants  but  also  older 
persons  should  be  protected  against  the  possibility 
of  infection,  if  we  have  any  reason  to  fear  that  the 


THE   C ASSEL  LECTURE.  43 

alimentary  tract  is  anywhere  deficient  in  its  protec- 
tive epithelial  covering.  I  have  already  pointed  out 
the  importance  of  the  exanthemata  in  this  respect, 
and  I  need  only  remind  you  of  the  many  other  dis- 
turbances associated  with  the  shedding  of  epithelium, 
disturbances  due  to  catching  cold,  to  indigestion, 
or  the  after-effects  of  certain  diseases  associated 
with  intestinal  ulceration,  etc.  There  is  one  other 
condition  which  I  must  not  fail  to  mention,  namely, 
the  temporary  exacerbations  of  a  tubercular  process, 
in  which  one  cannot  be  too  careful  in  ordering  the 
diet.  For  that  large  class  of  individuals  threatened 
with  consumption,  I  believe  we  have  a  valuable 
healing  agent  in  the  dietetic  therapy  made  promi- 
nent during  the  past  decade,  especially  by  von 
Leyden  and  his  pupils.  In  the  same  sense  we  must 
regard  the  temporary  residence  of  tuberculous 
individuals  in  sanitaria  as  most  valuable,  for  even 
if  the  lesions  do  not  heal  there,  the  progressive 
downward  course  of  the  disease  is  checked  and  the 
patients  learn  for  the  rest  of  their  lives  to  appreciate 
what  will  benefit  and  what  will  harm  them.  In 
many  cases,  therefore,  these  sanitaria  will  prove 
themselves  homes  for  the  prevention  of  consump- 
tion, even  if  they  are  not  homes  for  the  cure  of 
tuberculosis. 

My  own  efforts  in  the  field  of  tubercular  thera- 
peutics do  not,  to  be  sure,  concern  themselves  with 
sanitarium  treatment.  Their  last  aim  is  to  make 
all  homes  for  the  prevention  of  consumption,  all  sani- 


44  THE  SUPPRESSION   OF    TUBERCULOSIS. 

taria,  etc.,  unnecessary  by  means  of  a  protective  agent 
similar  to  that  by  which  Jenner  made  smallpox 
pest-houses  unnecessary.  Institutions  for  persons 
bodily  wrecked  are  like  those  for  persons  morally 
wrecked;  they  are  products  of  our  civilization,  but 
not  desirable  products.  At  best  they  are  necessary 
evils. 


OBSERVATIONS    CONCERNING   THE    STUDY 

OF  PHTHISIOGENESIS  IN  MAN  AND 

IN  ANIMALS. 

1.  It  is  possible  in  experiments  on  guinea-pigs 
to  produce  pulmonary  phthisis  by  infecting  these 
animals  from  the  oral  cavity  in  such  a  manner  that 
every  direct  infection  of  the  lungs  (alveolar  infec- 
tion through  the  trachea  =  aerogenous  infection 
of  the  lung)  is  excluded. 

(a)  Infection  through  the  parenchyma  of  the 

tongue. 

(6)  Feeding  of  tubercle  bacilli  with  milk. 

2.  Ascribing  the  pulmonary  phthisis  which  I  suc- 
ceeded in  producing  experimentally  to  a  lymphog- 
enous or  hematogenous  infection  of  the  lung 
following  previous  scrofulous  disease.  Definition 
of  the  term  "scrofula":  multiple,  caseating  areas 
of  disease  in  lymph-glands  and  in  other  organs, 
caused  by  Tb.  infection.  Concerning  the  ety- 
mology of  the  word  "  scrofula  "  (Greek  =  choeraden) , 
see  Virchow's  "Geschwülste,"  Vol.  II,  p.  558- 

3.  Other    varieties    of    experimental    phthisio- 

genesis ; 

45 


46  THE  SUPPRESSION   OF   TUBERCULOSIS, 

(a)  V.  Baumgarten's  experimental  method  of 
causing  pulmonary  phthisis  by  means  of  primary 
infection  of  the  urogenital  apparatus. 

{h)  The  experiments  of  Troje  and  Tangl  with 
tubercle  bacilli  artificially  weakened  in  virulence. 

4.  Critical  analysis  of  the  so-called  ''Inhalation 
Tuberculosis"  of  guinea-pigs  and  rabbits. 

(a)  My  own  experiments,  in  which  the  typical 
picture  heretofore  regarded  as  that  of  an  inhala- 
tion tuberculosis,  in  the  sense  of  an  aerogenous 
alveolar  infection,  was  produced  by  lymphog- 
enous or  haematogenous  introduction  of  tubercle 
bacilli,  with  the  complete  exclusion  of  a  primary 
alveolar  or  bronchial  infection. 

ih)  The  experiments  of  Weleminsky  (Hüppe). 

(c)  Signs  distinguishing  tubercular  pulmonary 
consumption  from  so-called  inhalation  tuber- 
culosis. 

5.  Improbability,  so  far  as  importance  as  a 
phthisiogenetic  factor  is  concerned,  of  a  primary 
bronchial,  or  even  primary  alveolar  Tb.  infection 
following  aerogenous  introduction  of  Tb.  into  the 
mouth  and  nose,  through  the  inhalation  of  dust  or 
droplets  containing  tubercle  bacilli. 

6.  Proof  for  my  assumptions, 

(a)  That  inhaled  tubercle  bacilli  under  circum- 
stances occurring  in  nature  are  taken  up  by  the 
lymphatic  receptive  apparatus  without  exciting, 
at  the  point  of  entry  into  the  lymph-channels, 
any  tubercular  disease, 


THE    STUDY   OF   PHTHISIOCENESIS.  47 

{b)  That  inhaled  tubercle  bacilli,  after  they 
have  entered  the  lymph-channels  of  the  throat, 
take  the  following  courses:  some  find  lodgment 
in  the  submental  glands  and  glands  of  the  neck; 
some  are  transported  to  the  mediastinal  (bron- 
chial?) glands;  some  gain  the  circulation  and 
thus  cause  hematogenous  infections,  especially 
at  the  peripheral  (sub-pleural)  endings  of  the 
pulmonary  artery,  from  which  then  the  lung 
parenchyma  can  be  infected;  finally,  some  are 
carried  through  the  stomach  to  the  lowest  por- 
tions of  the  intestines,  from  where  they  can  reach 
the  mesenteric  lymph-glands,  the  portal  vein, 
and  the  peritoneum. 

(c)  That  the  introduction  of  Tb.  into  the 
lymph-channels  is  accomplished  primarily  by 
the  leucocytic  wandering  cell,  which  takes  up 
the  tubercle  bacillus. 

7.  In  the  herbivora  the  Tb.  are  most  commonly 
carried  from  the  cecum  to  the  mesenteric  lymph- 
glands.  In  man,  the  agminated  lymph-follicles  of 
the  small,  and  the  solitary  lymph-follicles  of  the 
large  intestine  also  serve  as  points  of  entry  (cf. 
Carl  Hof,  ''Ueber  primäre  Darmtuberculose, "  Kieler 
Dissert.,  1903.  Compare  also  v.  Hansemann,  "  Ueber 
Fütterungs  Tuberculose,"  Berl.  klin,  Wochenschr., 
1903,  No.  7): 

8.  Reference  to  the  peculiar  features  of  the 
stomach  of  ruminants  and  remarks  on  primary 
tuberculosis  of  the  stomach  (Schottelius) , 


48  THE   SUPPRESSION   OF   TUBERCULOSIS. 

9.  The  primary  development  of  localized  foci  in 
the  lesser  omentum  after  infection  through  the 
stomach  in  early  nursing  period. 

10.  Peculiarities  of  the  infection  of  nurslings 
through  the  alimentary  tract,  experimentally  and 
statistically  determined. 

(a)  Feeding  experiments  with  anthrax  bacilli 
and  other  bacteria. 

(6)   Feeding  of  spores. 

(c)  Tubercular  virus  behaves  in  many  ways 
more  like  the  resistant  form  [spore  form]  of 
anthrax  virus,  especially  when  the  Tb.  virus 
is  present  in  cheesy  pus. 

{d)  The  observations  of  Adalbert  Czerny  and 
Paul  Moser  on  the  occurrence  of  bacteria  in  the 
blood  of  living  human  nurslings  (1894). 

{e)  Carl  Weigert's  statements  concerning  the 
penetrability,  for  Tb.  virus,  of  the  intestinal 
apparatus  of  very  young  children.  (From  1883, 
cited  in  Deutsche  medizin.  Wochenschr.,  1903, 
No.  41.) 

(/)  Raw's  commimication  (British  Med.  Journ., 
1903)  concerning  300  cases  of  tabes  mesenterica, 
not  one  of  which  was  found  to  have  developed 
in  a  child  nursed  exclusively  at  the  breast,  but 
rather  in  those  who  had  been  nourished  for  a 
considerable  time  on  cow's  milk. 

11.  It  is  probable  that  in  thickly  populated 
coimtries  practically  every  person  is  at  some  time 
or   other  infected   with   tuberculosis.     Aside  from 


THE  STUDY   OF   PHTHISIOGENESIS.  49 

the  quantity  and  quality  of  the  Tb.  virus,  the  out- 
come of  the  tubercular  infection  is  dependent  to  a 
high  degree  on  the  physiological  state  of  the  in- 
fected individual  and  on  accidental  conditions  of 
infection.  (Intercurrent  pathological  factors;  en- 
dogenous and  exogenous  conditions  of  infec- 
tion.) 

12.  Not  a  single  unexceptionable  case  has  been 
brought  forward  to  show  that  under  the  conditions 
of  life  usually  present  in  civilized  lands,  an  adult 
person  has  ever  contracted  pulmonary,  bronchial, 
tracheal,  or  laryngeal  tuberculosis  without  having 
previously  been  infected  and  thus  rendered  over- 
sensitive to  the  tubercular  poison. 

13.  Against  the  action  of  tubercle  bacilli  entering 
the  intestinal  apparatus,  healthy,  full-grown  persons 
apparently  possess  sufficient  protection  in  the  char- 
acter of  the  mucous  surfaces  and  the  anti-bacterial 
action  of  the  digestive  juices.  It  has,  too,  still  to  be 
proved  that  healthy,  full-grown  persons  become 
ill  with  tuberculosis  as  a  result  of  eating  food  (milk, 
butter,   meat)   derived  from  tuberculous  cattle. 

14.  Very  probably  adult  persons  frequently 
acquire  intestinal  tuberculosis  through  food  con- 
taining tubercle  bacilli,  if  the  epithelial  covering  of 
the  intestinal  mucosa  is  defective,  or  if  perhaps  there 
exist  ulcers  which  extend  down  to  the  parenchyma 
of  the  wall  of  the  alimentary  tract.  (Exanthematic 
diseases,  typhoid,  dysentery,  carcinoma,  etc.) 

15.  Whether  adult  persons  in  whom  the  condi" 


5°  THE  SUPPRESSION  OF   TUBERCULOSIS. 

tions  are  favorable  for  an  intestinal  infection  with 
Tb.  will  develop  primary  tubercular  lesions  in  the 
intestinal  wall,  or  in  the  raesenteric  glands  and  the 
peritoneum,  will  depend  mainly  on  the  circumstance 
whether  or  not,  owing  to  a  previous  infection,  they 
have  become  oversensitive  to  tuberculin.  Indi- 
viduals oversensitive  to  tuberculin  are  inclined  to 
develop  lesions  at  the  point  of  entry  of  the  tubercular 
vir  lis,  if  opportunity  is  given  for  the  introduction 
of  the  virus  by  means  of  leucocytic  wandering  cells. 
This  opportunity  is  lacking  in  the  virile  infecting 
period  at  such  places  where  the  lymphatic  receptive 
apparatus  is  destroyed  [verödet].  (Mucous  surfaces 
of  the  faucial  ring  of  consumptives?) 

1 6.  In  order  to  explain  the  mode  of  origin  of 
cheesy  pneumonias  and  tubercular  broncho-pneu- 
monias it  is  necessary  at  autopsy  to  regard  most 
carefully  the  possible  direct  extension  of  the  infec- 
tion from  cheesy  mediastinal  and  bronchial  glands 
to  the  bronchi  and  their  branches,  before  think- 
ing of  aerogenous  or  hsematogenous  pathogenesis. 
(Compare  [Ribbert]  Sievers,  ''Marburg  Disserta- 
tion," Aug.    14,    1902.) 

17.  Critical  analysis  of  several  statistical  state- 
ments which  seek  to  show  that  alveolar  pulmonary 
tuberculosis  is  referable  directly  to  inhaled  tubercle 
bacilli;  especially  the  statement  of  Knopf  (New 
York)  cited  by  Mitulescu  {Zeitschrift  für  Hygiene, 
1903),  that  in  Lansing,  Mich.,  twenty  employes 
of  a  library  became  CQUSumptive  through  handling 


THE   STUDY   OF   PHTHISIOGENESIS.  5 1 

Tb.  laden  books. ^  Probability  of  the  correctness 
of  my  assumption  that  Knopf  was  misled  by  un- 
scientific communications  from  Lansing.  Proof 
that  Mitulescu  again  misunderstood  Knopf. 

1 8.  It  has  not  yet  been  proved  that  persons 
cutaneously  infected  with  human  or  bovine  Tb. 
have  as  a  result  of  this  developed  phthisis.  (^ly 
own  observations  on  cases  of  infection  on  the  hand 
in  persons  working  with  tubercle  bacilli  of  various 
origins.) 

19.  Justification  of  the  statement  by  Virchow  in 
his  **Phymatie,  Tuberculose  und  Granulie, "  that 
"the  history  of  phthisis  is  concerned  much  more 
with  cheesy  hepatization  than  with  tubercles" 
(Virchow's  "Tuberkel,"   Begriff). 

20.  The  analysis  of  the  origin  of  pulmonary  con- 
sumption must  begin  with  the  primary  attack 
(primary  regionally  as  well  as  chronologically)  of 
the  Tb.  introduced  into  the  organism. 

21.  As  a  rule  we  can  regard  as  points  of  primary 
infection  polynuclear  leucocytes  in  the  blood  and 
lymphatic  receptive  apparatus ;  next  in  order  are  the 
muscular  elements  in  the  walls  of  the  smallest  blood- 
vessels. Endothelium  and  epithelium  may  become 
carriers  of  Tb.  through  the  action  of  polynuclear 
leucocytes  which  have  wandered  into  these  tissues. 

22.  In  studying  the  results  of  an  infection  with 
tubercular  virus,  aside  from  the  degree  of  virulence, 

^  See  appendix,  page  84, 


52  THE  SUPPRESSION   OF   TUBERCULOSIS. 

from  the  dosage,  the  single  or  repeated  Tb.  inocu- 
lation, and  the  primary  point  of  attack  (regional 
and  cellular),  we  have  particularly  to  consider  the 
age  at  which  the  primary  infection  occurs.  I  dis- 
tinguish four  periods : 

(a)   Infantile  period  of  infection ; 

(6)   Puerile         "       " 

{c)   Virile  "       " 

{d)  Senile  "       " 

23.  It  seems  to  me  that  in  the  epidemiological 
origin  of  pulmonary  consumption  the  infantile 
Tb.  infection,  followed  by  latent  or  manifest  scrofula 
in  the  puerile  period,  is  of  great  significance,  so  that 
we  can  formulate  the  following  doctrine:  ''An  in- 
fantile tubercular  infection  predisposes  to  tubercular 
pulmonary  consumption  J'  Under  ''scrofula"  I  here 
include  the  alteration  in  the  muscle  of  the  blood- 
vessels, caused  by  the  Tb.  infection,  which  finds 
its  expression  in  the  increased  sensitiveness  to 
tuberculin,  and  which  in  general  is  equivalent  to 
"scrofulous  diathesis"  of  the  older  authors. 

24.  The  primary  infection  from  the  mouth  or 
nose  with  tubercular  virus  derived  from  food  or  even 
from  inhalation,  in  the  small  quantities  that  under 
ordinary  conditions  of  life  are  concerned,  is  followed 
after  the  bacilli  have  entered  the  circulation,  by 
alterations  in  the  walls  of  the  smallest  vessels. 
These  manifest  themselves  as  follows: 

(a)  Microscopically,  by  a  loosening  of  the  vessel 
wall,  between  whose  elements,  shortly  after  the 


THE  STUDY   OF   PHTHISIOGENESIS.  53 

infection,  tubercle  bacilli  can  be  found.  These 
bacilli,  brought  here  by  the  wandering  cells,  are 
set  free  on  the  destruction  of  the  cells. 

(6)  In  primary  functional  disturbances  which 
can  be  recognized  by  the  temperature  curve  and 
the  heart  action. 

{c)  In  secondary  tuberculin  hypersensitiveness. 

25.  Following  mild  infections  the  alterations  in 
the  vessel  walls  may  retrogress  with  a  suppression 
[Beseitigung]  of  the  tubercle  bacilli.  Without  excep- 
tion, however,  the  hypersensitiveness  to  tuber- 
culin remains,  varying  in  degree  and  length  of  time 
according  to  the  virulence  of  the  infecting  Tb.  and 
to  their  more  or  less  locally  limited  action  on  the 
vascular  system. 

26.  After  a  moderately  severe  infection  there  is 
a  formation  of  transparent,  submiliary  eruptions 
(nowadays  our  "gray  miliary  tubercle"),  especially 
about  the  smallest  vessels  of  serous  membranes. 
These  eruptions  are  capable  of  becoming  organized. 
In  fact,  when  they  have  healed  they  form  a  tissue  en- 
tirely identical  with  the  tissue  in  which  they  originated. 
(Bichat,  Lebert,  Empis,  and  many  other  older  in- 
vestigators.) Aufrecht,  Deutsch.  Arch.  f.  klin.  Med., 
Vol.  LXXV. 

27.  The  introduction  of  a  tubercular  virus  so 
strong  as  to  cause  the  smallest  vessels  to  become 
occluded,  especially  Cohnheim's  terminal  arteries 
of  the  spleen,  lungs,  and  kidneys,  results  in  the 
exudation  of  a  coagulable  fluid  and  in  necrobiosis 


54  THE  SUPPRESSION   OF   TUBERCULOSIS. 

of  the  extravascular  region  supplied  by  those  ves- 
sels. (Aufrecht,  Arch.  /.  klin.  Med.,  Vol.  LXXV.) 
Into  this  dead  area  tubercle  bacilli  are  dragged  by 
the  wandering  cells.  These  bacilli  multiply  and 
cause  chemical  changes  which  manifest  themselves 
first  in  a  fatty  (steatomatous)  and  then  in  a  cheesy 
metamorphosis.  (Cf.  Koch,  Volume  II  of  the  Mit- 
iheilungen  aus  dem  Kaiserlich.  Gesundheitsamt,'' 
p.  21,  and  Plate  IX,  Figs.  45  and  46);  my  own 
observations ;  Aufrecht,  1.  c. ;  compare  also  the 
critical  reference  by  Virchow  to  the  works  of  older 
authors,  such  as  Vetter,  Gendrin,  Lobst  ein,  Cru- 
veilhier,  Bayle,  Baillie,  Laennec,  Rilliet  and  Barthez, 
Vulpian,  Craigie,  etc.,  in  "Phymatie,  Tuberculose 
und  Granulie,"  and  in  Vol.  II  of  ''Die  Krankhaften 
Geschwülste." 

28.  We  may  enumerate  as  the  result  of  primary 
tubercular  focal  disease 

(a)  Anatomically  demonstrable  residues. 
(Jd)  Functional  alterations. 

29.  Functional  alterations  may  remain  without 
any  anatomically  demonstrable  residues  of  the 
primary  infectious  processes.  I  divide  functional 
alterations  into 

(a)  Alterations  which  leave  behind  them  an 
immunity  against  living  Tb.  virus,  probably  to 
be  sought  for  in  the  peculiar  condition  of  the 
vessel  musculature  and,  in  the  beginning  at  least, 
always  associated  with  hypersensitiveness  to  the 
soluble  tubercular  poisons. 


THE   STUDY   OF  PHTHISIOGENESIS.  55 

(b)  Scrofulous  diathesis,  consisting  in  such 
changes  in  the  vascular  system  and  the  lymphatic 
apparatus  that  a  renewed  Tb.  infection  very 
readily  causes  cheesy  tubercular  lesions. 

30.  As  scrofulous  infectious  processes,  I  regard 

(a)  Lupus,  which  I  interpret  as  a  cutaneous 
additional  effect  of  a  tubercular  infection. 

(b)  Gland  scrofula,^  inclusive  of  tuberculosis 
of  the  mediastinal,  bronchial,  and  mesenteric 
glands. 

(c)  Bone  scrofula  and  joint  scrofula. 

(d)  Scrofula  in  the  domain  of  the  external  body 
covering,  of  the  mucous  membranes,  and  of  the 
lymph-channels. 

(e)  Cheesy  metamorphosis  in  internal  organs, 
inclusive  of  the  organs  of  sense,  and  the  vessel 
intima. 

31.  The  acute  miliary  tuberculosis  in  man,  which 
can  be  clinically  diagnosticated,  is  to  be  regarded 
as  a  provocative  secondary  infection,  resulting  from 
scrofula  of  the  blood-vessels'  intima  when,  on  the 
disintegration  of  cheesy  intima  tubercles,  a  great 
many  tubercle  bacilli  are  thrown  into  the  circula- 
tion at  once.      (Weigert-Ponfick.) 

32.  Disease  of  the  lung  apices    occurring  in  the 


^  It  will  be  well  to  retain  the  name  "Scrofula"  for  those  tubercular 
processes  outside  of  the  lung  which  go  on  with  cheesy  degeneration. 
Only  in  that  way  can  the  connection  between  the  histogenetically  so 
important  results  of  earlier  investigations  be  maintained. 


$6  THE   SUPPRESSION   OF    TUBERCULOSIS. 

virile  period  of  infection  and,  because  of  its  im- 
portant bearing  on  the  origin  of  consumption,  con- 
sidered separately,  is  preceded  by  the  consequences 
of  an  infantile  infection.  Foremost  among  these  is 
the  secondary  hypoplasia  of  the  smooth,  muscle 
tissue  (of  vessels,  bronchi,  and  intestinal  wall) ; 
next  in  order  come  wasting  [Veröding]  of  the  lym- 
phatic apparatus  (quantitative  and  qualitative  re- 
duction of  the  follicular  receptive  apparatus  of  the 
tubus  alimentär ius) ;  destruction  of  lymph-glands; 
and  the  secondary  hypoplasia  of  other  primary 
points  of  attack  for  Tb.  action  (in  the  spleen,  bone- 
marrow  cavities,  on  serous  surfaces  of  the  large 
body  cavities,  and  of  the  joints).  The  predilection 
of  the  thoracic  dome  for  immobilizing  changes  can 
probably  be  ascribed  to  its  exposure  to  the  Tb. 
infection  in  connection  with  precedent  mediastinal- 
gland  scrofula;  while  the  predilection  of  the  Itmg 
apices  for  caseating  lesions  can  again  be  brought 
into  causal  relation  with  secondary  ossifying  proc- 
esses, of  scrofulous  origin,  in  the  joint  structures 
of  the  thoracic  dome  (cf.  Aufrecht,  1.  c). 

33.  In  my  experiments  on  tubercular  cattle  I 
succeeded  in  producing  eruptions  of  gray,  non- 
caseating  tubercles,  running  an  acute  course,  by 
means  of  injections  of  tuberculin.  At  the  same 
time  it  was  noticed  that  not  infrequently  after  the 
intercurrent  exacerbation  had  subsided,  the  old 
infectious  process  had  been  favorably  influenced. 

34.  Even  when  caseating  lesions  are  present,  the 


THE  STUDY   OF  PHTHISIOGENESIS.  57 

simultaneously  developing  submiliary  transparent 
eruptions  (granulie,  of  the  older  authors)  are  to  be 
regarded  as  capable  of  being  organized  and  spon- 
taneously cured.  They  are  much  more  numerous 
in  man  than  has  heretofore  been  assumed.  This  is 
shown,  for  example,  by  the  fact  that  upon  opening 
the  abdominal  cavity  of  such  young  individuals  as 
showed  no  clinically  diagnosticated  symptoms  of  a 
miliary  tuberculosis,  these  eruptions  were  by  chance 
demonstrated. 

It  is  of  the  highest  interest  to  determine  the  fate 
of  such  individuals  with  a  healed  miliary  tuber- 
culosis of  the  peritoneum,  that  is,  whether  in  virile 
period  of  life  the  disposition  in  them  to  pulmonary 
consumption  is  increased  or  diminished. 

35.  The  clinical  picture  of  scrofula  in  the  puerile 
period  of  infection  is  etiologically  complicated  by 
other  infectious  processes,  especially  in  the  domain 
of  the  outer  body  covering.  The  fimctional  altera- 
tions in  the  vascular  system,  due  to  an  infantile  Tb. 
infection,  find  their  expression  not  only  in  the 
organism's  increased  sensitiveness  to  tuberculin,  but 
also  in  a  marked  instability  [labilität]  of  the  dynamic 
equilibrium  of  the  circulation  (lymphatic  constitu- 
tion). In  consequence  of  this,  eczematous  erup- 
tions due  to  parasitic  and  toxic  agents  result  much 
more  readily  in  these  individuals  than  in  those 
who  have  not  suffered  such  an  infantile  Tb.  in- 
fection   (one   incompletely  healed) . 

36.  The  symptoms  of  the  so-called   ''inclination 


58  THE  SUPPRESSION  OF   TUBERCULOSIS. 

to  consumption"  are  the  expression  of  a  defective 
overcoming  of  the  infantile  and  puerile  infectious 
periods.  The  hindered  development  and  weakness 
of  the  organs  made  up  of  smooth  muscle  fibres 
(muscles  of  the  blood-vessels,  intestinal  wall,  and 
bronchi)  are  comprehensible  when  we  remember  the 
great  share  that  the  smooth  muscle  tissue  has  in  the 
reaction  against  the  Tb.  circulating  in  the  blood. 
The  question  whether  the  weakened  conditions  and 
hindered  development  in  the  domain  of  the  striped 
muscles  are  due  directly  or  indirectly  to  the  Tb. 
infection  cannot  be  answered  without  further  in- 
vestigations. Similarly,  we  do  not  yet  know  the 
mechanism  of  the  origin  of  the  chest  anomalies 
seen  in  candidates  for  consumption.  A  partial 
impoverishment  of  the  intestinal  lymphatic  recep- 
tive apparatus  is  presumably  accountable  for  the 
fact  that  even  a  plentiful  supply  of  food  is  unable 
to  increase  the  accumulation  of  fat. 

37.  The  possibility  must  also  be  considered  that 
in  the  course  of  the  puerile  period  of  infection  the 
development  of  a  caseating  tubercle  may  proceed 
in  the  joint  tissues  between  costal  cartilage  and 
breast -bone,  and  that  such  a  scrofulous  thoracic 
affection  is  clinically  much  less  readily  diagnosed 
than  a  similar  affection  in  bones  of  the  extremities. 
Further,  that  such  a  lesion  in  the  lower  extremity 
is  much  more  readily  recognized  than  one  in  the 
upper  extremity,  since  even  slight  alterations  in 
the  bony  tissues  of  the  lower  extremity,  because  of 


THE  STUDY   OF  PHTHISIOGENESIS.  59 

functional    disturbances    in    walking    and    running, 
make  themselves  manifest. 

38.  For  a  detailed  analysis  of  the  origin  of  pul- 
monary consumption,  beside  the  results  of  infantile 
and  puerile  infections,  there  must  still  be  considered 

(a)  Additional  virile  Tb.  infections  (cf.  Rom- 
berg, Deutsch.  Arch.  f.  klin.  Med.,  1903). 

(6)  Combined  action  of  a  complicating  infec- 
tion. 

{c)  The  co-action  of  general  hygienic  and 
dietetic  injuries. 

39.  For  my  plans  for  suppression  of  tuberculosis, 
therefore,  the  following  points  are  essential: 

(a)  Prevention  of  the  introduction  of  Tb.  with 
food,  especially  with  milk,  during  infantile  life. 

{h)  Introducing  Tb.  anti-bodies  with  the  milk 
in  earliest  infancy  in  order  to  render  innocuous 
any  inhaled  tubercle  bacilli. 

40.  I  have  made  separate  communications  re- 
garding feeding  with  Tb.-free  milk.  The  produc- 
tion of  such  a  milk  will  be  very  easy  if  my  method 
of  cattle  immunization  in  practice  fulfils  the  hopes 
which  I  have  for  it ;  and  these  hopes  I  am  convinced 
are  fully  justified. 

41.  In  order  to  produce  immunity  by  means  of 
anti-bodies  it  is  probable  that  anti-bodies  derived 
elsewhere  will  have  to  be  added  to  the  milk  given 
to  infants. 


SUGGESTIONS  CONCERNING  THE  HYGIENE 
OF   COW-STABLES   AND     THE    PRODUC- 
TION OF   MILK  FOR  INFANT-FEED- 
ING, WITH  SPECIAL  REFERENCE 
TO  TUBERCULOSIS. 

The  Bonn  Rules. 

1.  Until  it  has  been  definitely  decided  whether  or 
not  my  protective  cattle  inoculation  protects  cattle 
against  tuberculosis  when  these  are  kept  in.  stalls 
or  herds  strongly  infected  with  Tb.  virus,  it  should 
be  sought  to  reduce  the  danger  of  infection  as  much 
as  possible  by  following  Ostertag's  recommenda- 
tions and  segregating  all  the  cattle  with  an  open 
tuberculosis. 

2.  The  milk  of  cows  which  react  positively  to 
tuberculin  must  not  be  used  for  feeding  calves, 
nor,  of  course,  for  infant-feeding. 

3.  Whenever  the  circumstances  permit,  the  sepa- 
rate housing  of  the  protectively  inoculated  animals 
in  a  stable  free  from  tuberculosis  is  to  be  recom- 
mended. In  constructing  new  stables  it  is  strongly 
urged  that  in  place  of  one  large  stable,  several  small 

60 


THE  HYGIENE   OF   COW -STABLES,  ETC.  6 1 

ones  be  erected;  besides  this,  attention  should  be 
paid  to  the  placing  of  the  animals.  They  should 
be  placed  with  the  heads  toward  the  lateral  walls, 
and  not  head  to  head,  facing  a  common  feeding- 
trough  along  the  middle  of  the  stable.^ 

4.  Particular  attention  should  be  paid  to  the 
cleanliness  of  the  feeding-troughs.  Every  fourteen 
days  they  are  to  be  filled  with  hot  water  and  freed 
from  any  adherent  dirt  by  mechanical  means. 
The  feeding-buckets  are  to  be  similarly  cleansed 
from  time  to  time. 

5.  The  drinking-water  supplied  to  cattle  should 
meet  essentially  the  same  requirements  as  are 
demanded  of  water  supphed  to  dwellings. 

6.  In  maintaining  the  health  of  the  yoimg  cattle 
an  important  factor  is  the  pasturage.  For  larger 
dairies  an  arrangement  used  at  our  Marburg  ex- 
perimental station,  consisting  of  a  lightly  con- 
structed shelter  within  a  large  enclosed  pasture, 
is  to  be  recommended. 

7.  The  disinfecting  of  infected  stables  is  to  be 
done  in  accordance  with  the  government  regula- 
tions. ^    [This  refers  to  the  German  regulations  of 

^  Rules  1,2,  and  3  have  been  purposely  neglected  in  certain  dairies  in 
Savar,  Teschen,  and  Mecklenburg,  as  can  be  seen  by  the  reports  of 
Messrs.  Strelinger,  Rosier,  and  Ebeling  {Beiträge  zur  experim.  Therapie, 
No.  8,  1904),  without,  thus  far,  injuring  the  inoculated  animals. 

^  §  2  includes  the  following  disinfecting  agents: 

1.  Water,  steam,  hot  water,  boiling  for  one  hour. 

2.  Soap-suds. 


02  THE  SUPPRESSION   OF   TUBERCULOSIS. 

June  23,  1880,  and  May  i,  1894.]  Here  it  is  to  be 
remarked  that  disinfection  of  the  stables  by  means 
of  formaldehyde  generation  is  not  even  then  ac- 
complished when  one  far  exceeds  the  requirements 
formulated  by  Flügge  for  the  Breslau  method. 
Utilizing  the  opportunity  presented  by  a  number 
of  courses  given  at  Marburg  in  the  method  of  making 
protective  inoculations,  etc.,  we  have  foimd  that 
even  in  the  stable  of  the  pest  laboratory  here,  which 
is  very  easily  closed  off,  the  above-mentioned 
formaldehyde  fumigation  is  ineffectual;  for  by 
treating  the  disinfected  objects  with  ammonia  water 
it  was  found  that  neither  anthrax  virus  nor  cocci, 
in  the  dry  state,  were  certainly  destroyed  by  the 
fumigation. 

8.  More  important  than  the  disinfection  by 
means  of  chemicals  is  the  prevention  of  the  accu- 
mulation of  infectious  materials  on  the  stable 
utensils,  in  the  food,   on  the   body  surface   of  the 

3.  Soda-lye  solution  (at  least  2  kilos  soda  in  100  liters  water). 

4.  Freshly  slaked  lime,  powder,  and  milk  of  lime,  1:2  aq.  and 
1 :  20  aq. 

5.  Sol.  chloride  of  lime,  i :  3  aq.  and  i :  20  aq. 

6.  Sol.  carbolic  acid,  5%. 

7.  Sol.  crude  cresol,  5%  (Liquor  cresoli  saponatus  of  the  German 
pharmacopoeia) . 

8.  Coal-tar  and  wood-tar. 

9.  Fire. 

The  most  rehable  and  cheapest  agent  for  rendering  harmless  Tb.  virus 
in  stables  is  hot  2%  soda  solution,  whenever  a  surface  disinfectant  is 
desired.  Disinfection  of  the  stable  air  is  as  yet  to  be  classed  only  as  a 
pious  wish. 


THE   HYGIENE   OF   COW-STABLES,  ETC.  63 

cattle,  on  the  body  and  clothing  of  the  staVjlemen. 
Training  the  stablemen  to  the  use  of  warm  or  hot 
water  and  soap;  the  use  of  towels  and  dishcloths 
which  have  been  rendered  germ-free  by  means  of 
hot  water  or  dry  heat  before  throwing  them  among 
the  soiled  clothes;  special  regard  to  a  rational  care 
of  the  milker's  hands,  including  the  removal  of  the 
dirt  under  the  nails;  all  of  these  are  the  most  im- 
portant measures  for  the  prevention  and  suppression 
of  stable  infection. 

9.  If  it  is  desired  to  secure  a  milk  as  free  from 
dirt  and  germs  as  possible  (not  over  400  germs 
per  c.c),  the  following  additional  measures  must  be 
taken : 

I.  Presupposing  that  the  milk  is  to  be  used  for 
infant-feeding,  the  same  is  to  be  filled  into  bottles 
holding  250  to  500  c.c.  All  parts  of  the  bottle, 
including  the  air-tight  and  germ-tight  closing  con- 
trivance, must  be  constructed  so  as  to  be  readily 
cleansed,  and  further,  so  that  they  can,  without 
injury,  be  sterilized  by  heat. 

II.  In  order  to  meet  all  the  requirements  for 
cleansing  and  sterilizing  milk-bottles,  the  following 
rules  are  recommended.  The  bottles  returned  by 
the  consumers  are  in  a  soiled  condition  and  con- 
tain fluid  remnants  of  milk: 

(a)  The  cleansing  of  the  bottles  should  be  un- 
dertaken in  a  well-ventilated  room  which  can 
readily  be  kept  clean  and  which  may  also  serve 
as  the  bottling  room.     This    room   is    to   be   so 


04  THE  SUPPRESSION   OF    TUBERCULOSIS. 

separated  from  the  stables  that  the  stable  odors 
cannot  gain  access. 

(6)  The  following  manipulations   are  required 
to  clean  the  bottles : 

(a)   Energetic  rinsing  with  io%  warm  soda 
solution. 

iß)  Rinsing  with  quartz  gravel  by  means  of 
a  stream  of  hot  water. 
(;-)   Cold  rinsing. 

{d)  Sterilization  in  the  dry  chamber.     These 
cleansing   m.anipulations   occupy    about    forty- 
five  minutes. 
III.  The   stable    itself    should  be    so   built   that 
It  can  readily   and   thoroughly    be  cleansed,    with 
special  regard  to  the  following  points: 

(a)  Draining  of  the  fluid  excreta,  etc.,  by 
means  of  drains  with  sufficient  pitch. 

{h)  Ready  removal  of  solid  refuse  without 
raising  dust. 

{c)  A  plentiful  supply,  by  means  of  pipes,  of 
pure,  wholesome  water.  Also  a  hot-water  supply 
for  cleansing  purposes. 

(d)  Good  ventilation  for  the  high  lying  stalls. 

(e)  Broad  alleys  separating  the  rows  of  stalls. 
(/)    Each  stall  to  be  constructed  in  such  manner 

that  the  cow  is  obliged  after  feeding  to  step  back, 
thus  compelling  her  to  empty  her  excreta  into 
an  open  drain  connected  with  the  main  drain. 
This  is  effected  by  means  of  the  so-called  "drop- 
railing  contrivance.'* 


THE   HYGIENE   OF   COW-STABLES,  ETC.  65 

{g)  Water-tight  flooring. 
IV.  The   spreading  of  peat  instead   of  straw  to 
keep  the  stalls  dry. 

10.  Another  deciding  factor  in  the  production  of 
a  pure  milk  for  infant-feeding  is  the  cleanliness  of 
the  stable  and  dairy  attendants,  the  milkers,  the 
cows,  and  the  stable  and  dairy  utensils. 

I.  Aside  from  general  body  cleanliness,  particular 
attention  is  to  be  given  to  a  healthy  condition  of 
the  milking  person's  hands.  Before  proceeding  to 
milk,  these  persons  are  to  don  a  clean  gown  made 
of  white  linen. 

11.  The  cows  are  to  be  kept  scrupulously  clean. 
The  udders  and  tails  are  to  be  so  clean  that  they 
can  be  touched  with  white-kid  gloves  without 
causing  appreciable  amounts  of  dirt  or  of  odorous 
substances  to  soil  them.  In  order  to  keep  the  udder 
and  teats  clean  the  following  is  recommended : 

Just  before  milking,  the  udder,  which  should 
always  be  kept  dry,  is  to  be  rubbed  off  with  a  clean 
flannel  cloth  which  has  been  greased  with  a  little 
lard.  By  this  means  dirt  and  odorous  substances 
are  most  readily  removed.  Following  this,  the  parts 
are  rubbed  dry  with  the  aid  of  a  little  bran. 

III.  The  milk  vessels  should  be  of  tinned  sheet 
iron. 

IV.  The  milk  should  be  strained  through  alumin- 
ium-nickel gauze  or  brass  gauze,  which  is  then  to 
be  cleaned  and  disinfected. 

V.  All  the  milk  of  one  milking  period  is  pumped 


66  THE   SUPPRESSION   OF    TUBERCULOSIS, 

high  into  the  bottling-room  and  conducted  into  a 
collecting  reservoir.  This  passage  to  the  reservoir, 
during  which  it  is  cooled  and  aired,  occupies  only 
a  few  minutes  and  the  milk  reaches  the  reservoir 
at  a  temperature  of  4^-5°  C. 

VI.  From  this  reservoir  the  milk  is  bottled  with- 
out delay  by  means  of  a  bottling-machine,  the  milk 
having  a  temperature  of  about  5°-7°  C.  on  bottling. 
A  temperature  of  less  than  2°  C.  has  an  injurious 
influence  on  the  anti-bacterial  substances  in  the  milk^ 
and  should  therefore  be  avoided. 

II.  If  the  milk  hygienic  rules  above  mentioned 
are  carefully  followed,  and  if  attention  is  paid  to 
the  experiences  regarding  a  rational  method  of 
feeding  milch  cows,  it  is  possible,  without  any 
further  method  of  preserving  the  milk,  to  have  the 
same  capable  of  being  transported  and  kept  for 
sixteen  hours  without  losing  its  adaptability  as  in- 
fant food.  In  Berlin  I  saw  such  a  milk  reach  the 
consumer  with  a  germ-content  of  not  over  1000 
germs  per  cubic  centimeter.  On  the  other  hand,  I 
have  seen  milk  derived  from  dirty  cows  and  collected 
without  particular  hygienic  precautions,  after 
being  transported  six  hours,  contain  a  hundred 
to  a  thousand  times  as  many  germs.  In  such 
cases,  soon  after  milking,  the  milk  often  contains 
from  30,000  to  100,000  gemis  per  cubic  centimeter. 

In  the  strictly  fresh  milk  from  my  own  cows 
the  number  of  germs  per  cubic  centimeter  varies 
from   10  to   50  to   200.     Such  milk  kept  at  room 


THE   HYGIENE   OF   COW -STABLES,  ETC.  67 

temperature  does  not  coagulate  until  after  three 
to  five  days. 

At  present  I  regard  1000  germs  per  cubic  centi- 
meter at  the  time  of  feeding  to  be  a  safe  limit  for 
milk  fed  to  infants. 

•  12.  If  a  milk  collected  in  accordance  with  the 
preceding  regulations  is  to  be  made  capable  of 
being  transported  and  kept  for  three  days  (in 
which  case  coagulation  factors  must  be  reckoned 
with)  without  losing  its  qualifications  as  an  infant 
food,  the  addition  of  formaldehyde  in  the  propor- 
tion of  I  :  40,000  (B.  f.  milk)  is  to  be  recommended. 

The  following  manipulations  are  then  to  be  carried 
out: 

I.  Preparing  a  formaldehyde  stock  solution  con- 
taining 0.5%  formaldehyde.  (One  part  of  com- 
mercial formaldehyde  and  79  parts  of  boiled  water.) 
This  solution  will  keep  for  two  or  three  days. 

II.  Pouring  50  c.c.  of  this  0.5%  stock  solution 
( =  .25  gramme  formaldehyde)  into  an  empty  tin  pail 
in  which  a  mark  has  been  made  at  the  lo-liter  level. 

III.  Milking  into  this  pail  up  to  the  mark. 

IV.  Straining,  airing,  cooling,  etc.,  according  to 
paragraph  10,  IV,  V,  and  VI. 

13.  In  order  not  to  conflict  with  the  government 
sanitary  regulations  the  milk  producers  at  present 
delivering  this  B.  f.  milk  have  agreed  to  supply  it 
only  to  certain  private  institutions  designated  by  me. 

14.  Should  the  authorities  later  decide  to  allow 
the  sale  of  this  B.  f.  milk,  it  is  recommended  that 


68  THE  SUPPRESSION   OF    TUBERCULOSIS. 

licenses  be  issued,  out  of  the  proceeds  of  which 
veterinary  physicians  be  appointed  to  see  that  this 
B.  f.  milk  is  produced  in  accordance  with  these 
regulations. 

15.  Containers  for  B.  f.  milk  should  have  trade- 
marked  labels  indicating  that  the  milk  has  been 
produced  in  conformity  with  the  requirements. 
Beside  this  the  label  should  bear  in  clear  figures 
the  time  and  date  of  milking. 

16.  Whenever  for  any  reason  it  is .  impossible  to 
raise  a  calf  directly  on  the  udder,  B.  f.  milk  should 
be  preferred  to  milk  sterilized  by  heat.  In  the 
production  of  B.  f.  milk  tubercular  and  suspected 
tubercular  cows  are  to  be  excluded  on  principle. 

17.  Where  it  is  desired  to  suppress  an  infectious 
process  in  the  digestive  system  of  cattle,  the  tem- 
porary employment  of  a  stronger  formaldehyde 
milk  (i  :  25,000  to  i  :  16,000)  under  the  direction 
of  a  veterinary  physician  is  recommended. 

18.  In  the  suppression  of  ''  Kälber  sterbe,''  beside 
the  increased  requirements  regarding  the  cleanli- 
ness of  attendants'  clothing  and  body,  of  stable 
and  stable  utensils,  the  proper  care  of  the  navel 
with  the  aid  of  a  |%  aqueous  solution  of  formal- 
dehyde is  recommended. 

19.  The  radical  suppression  of  bovine  tubercu- 
losis by  means  of  my  protective  inoculation  is  to 
be  sought  for. 

20.  The  following  article  shows  the  method  of  mak- 
ing these  inoculations  at  present  in  use  at  Marburg. 


SYNOPSIS  FOR  PROTECTIVE  INOCULATION 
OF   CATTLE   IN   AGRICULTURAL 
PRACTICE. 

GENERAL    CONSIDERATIONS. 

For  the  protective  inoculation  carried  out  by  us 
in  practice  we  make  use  of  "Mxt.  Tb."  in  the  form 
of  our  ''Culture  No.  i,"  which  has  been  studied 
by  us  for  years  and  which  we  have  minutely  de- 
scribed in  the  Beiträge,  Nos.  5  and  6.  The  accu- 
mulation of  orders  for  this  virus  on  the  one  hand 
and  the  multitudinous  experimental  labors  in  the 
institute  here  on  the  other,  compelled  us  to  rid 
ourselves  of  the  technical  labor  of  manufacture, 
weighing  off  and  shipping  of  the  virus,  which  ac- 
cordingly has  been  undertaken  by  the  local  firm 
of  Drs.  Sichert  &  Ziegenbein.  The  virus,  however, 
continues  to  be  tested  as  to  purity,  virulence,  etc., 
in  the  scientific  department  of  the  institute  at 
Marburg. 

The  virus  is  accompanied  by  directions  for  use 

which  have  already  appeared  in  the  Zeitschrift  für 

Thier-medicin.     These  are  as  follows: 

69 


70  THE  SUPPRESSION   OF    TUBERCULOSIS. 

I.  Selection  of  the  Animals  to  be  Inocu- 
lated.— ^As  a  rule  only  animals  without  external 
evidences  of  disease,  from  three  weeks  to  three 
months  (for  the  first  inoculation)  should  be  inocu- 
lated. In  healthy  animals  of  this  age  a  previous 
tuberculin  test  is  unnecessary,  even  if  the  animal 
comes  from  a  notoriously  tubercular  herd. 

II.  Numbering  the  Inoculated  Animals. — 
Every  inoculated  animal  must  be  marked  with  a 
rimning  number.  The  marking  must  be  of  such  a 
character  as  to  be  distinct,  not  liable  to  be  mis- 
taken for  some  other,  and  to  last  the  lifetime  of  the 
animal.  (Ear-marking,  tattooing,  etc.)  If  neces- 
sary, the  marking  is  to  be  repeated  should  the  first 
mark  become  indistinct. 

III.  Keeping  of  Records. — See  imder  "Condi- 
tions governing  the  distribution  of  the  virus,  etc.," 

P-  75. 

IV.  Technique  of  Taking  the  Temperature. 

— The  body  temperature  is  determined  by  means 
of  a  self-registering  thermometer  completely  in- 
serted into  the  rectum.  Before  introducing  it,  the 
rectum  is  to  be  cleared  of  any  hard  fecal  masses. 
A  tape  about  a  foot  long,  having  a  clamp  at  its  end, 
is  tied  to  the  neck  of  the  instrument.  The  ther- 
mometer is  left  in  the  rectum  for  four  minutes,  the 
clamp  meanwhile  being  fastened  to  the  hairs  at  the 
root  of  the  tail.  In  order  to  save  time,  thermome- 
ters are  introduced  into  a  number  of  animals  (about 
six)    consecutively.    When   the   last   thermometer 


PROTECTIVE  INOCULATION  OF  CATTLE.  7 1 

has  been  inserted  it  will  usually  be  time  to  extract 
and  read  the  first.  In  this  way  one  can  take 
the  temperature    of   fifty  head   of    cattle    in    i-ij 

hours. 

V.  The  Virus. — The  inoculating  virus  consists 
of  living  tubercle  bacilli  whose  action  has  been 
accurately  tested  in  the  Marburg  Institute  for 
Experimental  Therapy.  The  tubercle  bacilli  have 
been  dried  without  losing  their  vital  powers  in  any 
way.  These  dry  tubercle  bacilH  (Trocken  Tb.), 
kept  in  sealed  glass  tubes,  will  retain  their  action 
on  cattle  unchanged  for  a  period  of  thirty  days. 
If,  therefore,  a  tube  of  Tb.  bears  the  date  vii-i-02, 
the  contents  can  be  used  for  cattle  immmiization 
until  viii-i-02.  After  thirty  days,  although  the 
immunizing  power  is  not  entirely  lost,  it  is  so  far 
decreased  as  to  render  it  ineffective  in  the  dosage 
recommended. 

VI.  Dosage  of  the  Virus. — For  the  first  in- 
oculation, one  immunizing  unit,  i  I.  E.  [=1  Immun 
Einheit]  is  used  for  each  calf ;  for  the  second  inocu- 
lation, which  is  not  to  be  undertaken  imtil  at  least 
twelve  weeks  after  the  first,  five  units  (5  I.  E.)  are 
used  for  each  calf.  As  a  rule  the  dose  of  i  I.  E. 
is  0.004  gramme  dry  Tb.,  that  of  5  I.  E.  for  the 
second  inoculation  is  therefore  0.02  dry  Tb. 

If  the  tube  contains  the  quantity  requisite  for 
the  first  inoculation  of  twenty  cattle,  it  will  bear 
the  label  20  I.  E.  In  order  at  all  times  to  control 
the  manner  of  production  of  the  dry  Tb.  each  tube 


Op. 

No 

IV. 

20 

I. 

E. 

VII- 

-17- 

-02 

72  THE  SUPPRESSION   OF   TUBERCULOSIS. 

also    bears    in    Roman    numerals    the    consecutive 
laboratory  number  thus: 


This  label  is  interpreted  as  follows: 
Dry  Tb.,  which  in  the  records  of  the  Marburg 
Institute  bears  the  laboratory  number  IV,  con- 
tain on  the  day  of  deliver}^,  i.e.,  on  vii-17-02, 
twenty  immunizing  units,  and  retain  this  strength 
until  viii-17-02. 


For  the  inoculation  the  virus  is  uniformily  mixed 
with  1%  salt  solution  which  has  previously  been 
boiled  and  cooled.     The  procedure  is  as  follows: 

The  entire  contents  of  the  tube  are  placed  in  a 
small  mortar  and  crushed  with  the  pestle.  Then 
2  to  3  c.c.  salt  solution  are  added  and  the  whole 
rubbed  into  a  uniform  mixture  or  emulsion,  after 
which  it  is  poured  into  a  graduated  cylinder  holding 
50  c.c.  A  little  more  salt  solution  is  then  added 
to  the  mortar,  and  thus  the  remaining  particles 
of  virus  are  added  to  the  previous  mixture.  The 
fluid  in  the  graduate  is  then  made  up  to  30  c.c. 
with  salt  solution,  and  then  poured  into  a  sterile 
wide-mouthed  bottle  holding  100  c.c.  Any  re- 
maining emulsion  is  then  washed  out  of  the  graduate 
with  an  additional  10  c.c.  salt  solution  and  added 
to  the  30  c.c.  in  the  bottle.  The  bottle  thus  con- 
tains virus  ready  to  inoculate,  and  each  2  c.c.  will 
be  the  dose  for  the  first  inoculation  of  a  calf,  pro- 
vided that  the  tube  originally  contained  20  I.  E. 


PROTECTIVE  INOCULATION   OF  CATTLE.  73 

The  dose   for  a  second    inoculation  would  then  be 
contained  in  10  c.c.  of  this  fluid. 

VII.  Instrument  Case. — In  order  to  carry  out 
the  inoculations  in  agricultural  practice,  the  instru- 
ment case  constructed  by  W.  Holzhauer,  Marburg, 
is  to  be  recommended.     It  contains  the  following: 

(a)  Two  bottles  for  the  virus,  each  loo  c.c,  made 
of  colored  glass. 

(h)  One  bottle  lysol. 

{c)  One  bottle  alcohol. 

{d)  One  Erlenmeyer  flask  (for  1%  salt  solution). 

{e)  One  mortar  and  pestle. 

(/)  One  graduated  cylinder  50  c.c. 

{g)  One  graduated  cylinder  of  10  c.c. 

Qi)  One  basin  to  hold  disinfectant  solutions. 

{i)  Six  thermometers  with  tapes  and  clamps. 
(Price  10.50  marks  or  1.75  marks  each.) 

{k)  Two  virus  syringes  with  two  strong  canulas. 
(Price  II  marks.) 

(/)  One  small  hand-scale  and  weights. 

(w)  One  alcohol  stove  and  cover. 

{n)  Sterile  cotton. 

(0)  One  wire  basket. 
The  entire  box  is  supplied  with  a  canvas  cover 
and  a  leather  handle.  The  lid,  which  bears  four 
movable  legs,  can,  when  the  same  is  removed  from 
the  box,  be  set  up  like  a  saucepan  and  used  as  a 
sterilizer.  For  this  purpose  the  vessels  and  instru- 
ments are  placed  into  the  wire  basket,  the  sterilizer 
half -filled  with  2%  lysol  solution,  and   the  whole 


74  THE  SUPPRESSION  OF   TUBERCULOSIS. 

heated  just  to  boiling  by  means  of  the  alcohol  stove. 

The  price  of  the  complete  outfit  is  85  marks.  By 
omitting  the  thermometers  and  syringes  the  price 
is  reduced  to  63.50  marks. 

VIII.  Method  of  Making  the  Intravenous 
Injection. — The  injection  is  best  made  by  means 
of  a  5-c.c.  glass  syringe  with  an  asbestos  plimger 
(paragraph  VII,  ^),  which  is  cleaned  by  means  of  the 
lysol  solution  and  rinsed  in  sterile  salt  solution. 
The  canula  attached  to  the  syringe  is  cleaned  in  the 
same  manner.  One  immimizing  imit  (i  I.  E.)  is 
then  drawn  up  into  the  syringe  and  any  air-bubbles 
are  expelled,  care  being  taken  that  any  drops  of 
fluid  expelled  in  this  manner  do  not  fall  on  the  floor 
but  are  caught  up  in  the  basin.  The  filled  syringe, 
together  with  the  canula,  which  is  now  detached, 
is  then  placed  on  the  previously  mentioned  basin. 
The  virus  is  inj  ected  into  the  left  jugular  vein .  When 
possible  the  cattle  should  be  inoculated,  each  in  its 
own  stall,  so  as  to  avoid  exciting  them.  After  wash- 
ing the  left  side  of  the  neck  with  2%  lysol  solution, 
the  operator,  by  pressing  his  thumb  on  the  jugular 
vein,  stops  the  circulation,  causing  a  distinct,  sau- 
sage-shaped, fluctuating  swelling  to  appear.  With 
his  right  hand  he  now  takes  the  canula  from  the 
basin  and  thrusts  it,  just  above  the  compressing 
thimib,  upward  into  the  vein  at  an  angle  of  45°. 
One  recognizes  that  the  vein  has  been  entered,  by 
the  blood  that  at  once  flows  through  the  canula. 
If  no  blood  flows,  the  vein  has  not  been  entered. 


PROTECTIVE  INOCULATION   OF   CATTLE.  75 

In  that  case  the  canula  is  withdrawn  slightly  but 
not  completely,  and  again  thrust  into  the  fluctuat- 
ing swelling.  As  soon  as  blood  flows,  the  left  hand 
ceases  making  pressure  and  grasps  the  canula, 
whilst  the  right  hand  fits  the  syringe  thereto.  Then 
the  virus  is  slowly  and  uniformly  injected  into  the 
vein.  When  the  syringe  is  emptied,  the  skin  at  the 
site  of  injection  is  pressed  together  and  the  syringe 
and  canula  withdrawn.  As  a  rule,  bleeding  ceases 
almost  at  once.  The  region  is  then  rubbed  over 
with  2%  lysol  solution  and  the  inoculation  is  com- 
pleted.^ 

CONDITIONS    GOVERNING   THE   DISTRIBUTION   OF  THE 
VIRUS  PROTECTIVE  AGAINST  TUBERCULOSIS. 

1.  The  virus  is  supplied  by  the  firm  of  Drs.  Siebert 
&  Ziegenbein  in  Marburg  a.  d.  Lahn,  Germany. 

2.  This  firm  supplies  the  virus  in  packages  con- 
taining 5  I.  E.  and  20  I.  E.  The  price  for  the 
former  at  present  is  40  pf .  per  I.E.  and  for  the  latter 
25  pf.  per  I.  E.  In  ordering,  the  style  of  package 
is  to  be  specified. 

3.  The  recipients  bind  themselves  to  fill  out  and 
return  the  following  records: 

A.  Temperature  charts:  The  temperature  is  to 
be  recorded  as  a  curve. 

B.  Other  data  as  per  blank  herewith  enclosed 
(see  next  page). 


*  See  appendix,  page  84. 


76 


THE  SUPPRESSION  OF   TUBERCULOSIS. 


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PROTECTIVE   INOCULATION   OF   CATTLE.  77 

C.  General  report:  This  includes  a  report  on  the 
manner  of  keeping  the  inoculated  cattle,  the  hy- 
gienic conditions  of  the  stables,  previous  occurrence 
of  perlsucht  in  the  cattle  of  the  herd,  previous  use 
of  other  means  of  suppression  of  tuberculosis  and 
their  result,  etc.,  etc. 

4.  The  owners  of  the  cattle  must  see  to  it  that 
the  inoculations  are  properly  made  and  they  them» 
selves  must  bear  all  consequences  resulting  from 
defective  inoculation.  Drs.  Sichert  &  Ziegenbein 
can  in  no  way  accept  responsibility  for  this. 


The  preceding  conditions  are  still  adhered  to  in 
many  large  dairy  farms.  To  a  number  of  smaller 
dairies  we  have  allowed  easier  conditions.  An 
example  is  aiforded  in  the  following  order  of  the 
Ministry  of  the  Interior  of  the  Grandduchy  of 
Hesse. 

MINISTRY  OF  THE  INTERIOR  OF  THE  GRANDDUCHY 

OF    HESSE, 

Department  of  Public  Health, 

To  the  Grandducal  County  Veterinarians: 

Whereas,  following  the  proclamation  of  the  Min- 
istry of  the  Interior  dated  Aug.  19,  1902,  a  large 
number  of  replies  has  been  received  from  the 
farmers,  it  is  ordered  that  the  inoculations  be  here- 
after made  in  accordance  with  the  following  princi- 
ples: 


78  THE  SUPPRESSION   OF   TUBERCULOSIS. 

1.  The  protective  inoculation  consists  in  the  in- 
travenous injection  of  a  single  immunizing  tmit  of 
tubercle  germs  (derived  from  man),  rubbed  up 
with  sterile  salt  solution;  and  in  a  second  intra- 
venous injection,  three  months  later,  of  five  immu- 
nizing units  of  the  same  germs. 

2.  The  germs  in  question  can  be  obtained  in  glass 
tubes  containing  5  or  20  imits. 

3.  As  a  rule  only  cattle  without  external  mani- 
festations of  disease,  aged  from  three  weeks  to  four 
months  (at  the  first  inoculation)  should  be  inocu- 
lated. With  healthy  animals  of  this  age  it  is  un- 
necessary to  test  them  previously  with  tuberculin, 
even  if  they  belong  to  a  notoriously  tubercular 
herd. 

4.  In  exceptional  cases  older  animals  (from  four 
months  to  two  years)  may  be  inoculated  with  the 
virus,  but  only  when  they  are  entirely  free  from 
disease,  and  when  a  tuberculin  test  made  on  them  re- 
sults without  any  reaction  whatsoever. 

5.  The  inoculated  animals  are  to  be  kept  in  their 
stalls  two  days  before  and  two  weeks  after  the  in- 
oculation. 

6.  In  all  cases  in  which  the  owners  can  manage 
the  rectal  temperatures,  the  same  are  to  be  taken 
two  days  before  the  inoculation  (morning  and  even- 
ing) and  again  on  the  morning  of  the  inoculation. 
After  this  they  are  taken  once  more  in  the  evening 
and  then  once  daily  for  the  next  five  days.  If, 
after  this,  the  animals  still  have  temperatures  abov^ 


PROTECTIVE   INOCULATION   OF   CATTLE.  79 

39.2°  C,  the  temperatures  are  to  be  taken  daily  until 
the  same  reach  39.2°  C. 

7.  In  animals  not  over  four  months  old  at  the 
time  of  the  first  inoculation,  the  temperature  may- 
be omitted  if  there  be  any  difficulties  in  taking  it. 
In  those,  however,  which  are  over  that  age  at  the 
time  of  the  first  inoculation,  the  temperature  must 
invariably  be  recorded  according  to  paragraph  6. 
Even  when  inoculating  animals  in  infected  herds 
the  above-mentioned  measurements  should  be  taken 
whenever  practicable. 

8.  If  possible,  the  inoculated  animals  should  be 
weighed  every  fourteen  days  on  a  cattle  scale. 

9.  Owners  of  cattle  are  to  keep  record  of  all  the 
temperatures  and  weights.  You  are  to  collect  the 
records  concerning  temperatures  as  soon  as  they 
have  been  completed;  the  records  of  the  weights, 
however,  only  after  three  months.  The  results 
noted  in  the  temperature  returns  are  to  be  entered 
by  you  on  the  charts  herewith  provided,  and  a  tem- 
perature curve  plotted.  These  charts  are  to  be 
made  in  duplicate,  one  copy  to  be  sent  to  our  repre- 
sentative and  the  other  to  the  Experimental  Divi- 
sion of  the  Hygienic  Institute,  Marburg. 

10.  The  inoculated  animals  are  all  to  be  perma- 
nently marked.  Those  on  which  temperature  and 
weight  observations  have  been  made  should  also 
be  numbered. 

The  method  of  thus  marking  and  numbering  the 
animals  is  left  to  your  judgment, 


So  THE  SUPPRESSION   OF    TUBERCULOSIS. 

11.  Should  you  not  be  informed  in  regard  to  the 
previous  notifications  respecting  the  inoculations, 
kindly  place  yourself  in  communication  with  the 
grand-ducal  "Kreis  Amt."  Following  this,  as  soon 
as  you  have  informed  yourself  regarding  the  age 
and  health  of  the  animals  to  be  inoculated,  notify 
our  representative  as  to  the  number  of  these  animals 
suitable  for  inoculation.  The  reports  for  each  vil- 
lage are  to  be  made  out  separately. 

12.  The  necessary  virus  and  utensils,  as  well  as 
explicit  directions  for  use,  will  be  furnished  by  us. 

13.  We  shall  see  that  your  first  inoculation  is 

attended  by  our  representative. 

(Signed) 

Darmstadt,  Nov.  16,  1903. 


APPENDIX. 


NOTE    TO    PAGE    28. 

.  .  .  Nowadays,  however,  there  are  few  authori- 
ties who  do  not  admit  that  tubercle  bacilli  which 
have  gained  lodgment  in  the  nasopharynx  or  in 
the  oral  cavity  may  cause  primary  lesions  in  the 
lung  in  an  entirely  different  way  [different  from 
direct  infection  by  inhalation],  namely,  through 
lymphogenous  or  hcEmatogenous  channels  after  an 
intestinal  infection  (the  intestine  reckoned  from  the 
pharynx  down  through  the  stomach  to  the  rectum). 

Whether  this  inhalation  of  tubercle  bacilli  from 
the  air  into  the  nasopharynx  is  followed  by  a  pul- 
monary tuberculosis,  and  whether,  if  it  be  demon- 
strated that  this  actually  occurs,  the  disease  is  to 
be  ascribed  to  intestinal  or  pulmonary  infection,  is 
the  thema  probandum.  .  .  .  How  little  I  deny  the 
possibility  of  an  inhalation  of  tubercle  bacilli  and 
the  consequent  danger  of  infection  to  many  persons 
can  be  seen  from  two  quotations,  one  from  my 
Vienna  lecture,  March  12,  1903,  and  the  other  from 
the  lecture  held  at  Cassel,  Sept.  27,  1903. 

**In  my  plans  for  the  suppression  of  tuberculosis 

81 


Ö2  THE  SUPPRESSION   OF   TUBERCULOSIS. 

I  give  the  central  place  to  the  feeding  of  infants  with 
milk  both  harmless  and  capable  of  healing.  But 
as  already  stated  in  my  previous  commimications, 
it  is  absolutely  important  to  keep  coughing  con- 
sumptives away  from  the  nursing  infant.  The 
tubercular  virus  scattered  throughout  the  dwelling 
of  the  consumptive  surely  finds  its  way  in  one  way 
or  another  into  the  mouth  of  the  nursling,  and  then, 
just  like  the  tubercle  bacilli  in  the  milk,  it  reaches 
the  lymph-vessels  and  the  circulation.  It  will,  of 
course,  also  get  into  the  infant's  milk,  and  when, 
therefore,  in  my  lecture  in  Cassel,  I  stated  that  '  the 
milk  fed  to  infants  is  the  chief  cause  of  consump- 
tion,' I  presumed  that  my  auditors  and  readers 
were  familiar  with  the  following  paragraph  of  my 
Vienna  lecture :  '  If  I  may  apply  the  experiences 
gained  in  studying  the  conditions  imder  which 
tubercular  and  other  cattle  are  housed,  etc.,  I  must 
say  that  model  hygienic  housing  can  do  little  to 
prevent  the  spread  of  tuberculosis,  if  at  the  same 
time  the  scattering  of  tubercle  bacilli  by  the  cattle 
with  open  tuberculosis  is  not  prevented  or  at  least 
lessened.  It  is  absolutely  impossible  to  determine 
all  the  numerous  ways  in  which  tubercle  bacilli 
coughed  up,  or  otherwise  scattered  about  by  the 
tuberculous  animals,  will  finally  reach  the  organism 
of  the  other  cattle  in  the  stable ;  and  I  regard  it  as 
almost  impossible,  by  means  of  mechanical  or  other 
measures,  to  prevent  the  spread  of  virus  from  a  case 
of  open  tuberculosis  to  the  other  inmates  of  the 


APPENDIX.  83 

same  room.  For  adults  who,  in  healthy  circum- 
stances, possess  a  strong  protection  against  the 
action  of  the  tubercle  bacilli,  in  the  form  of  the 
epidermis,  the  epithelial  covering  of  the  mucous 
membranes,  and  the  anti-bacterial  ferments,  I 
regard  the  danger  of  infection  as  not  particularly- 
great,  provided,  of  course,  the  dose  introduced  is 
not  as  large  as  in  our  laboratory  experiments.  On 
the  other  hand,  the  new-born,  whose  mucous  mem- 
brane is  so  very  permeable  and  lacks  the  protective 
ferments,  are  so  very  much  exposed  to  the  danger 
that  I  cannot  conceive  such  individuals  escaping  in- 
fection if  they  be  in  the  same  room  with  a  coughing 
consumptive.  It  has  been  amply  proved  that  the 
air  can  carry  not  only  dry  but  also  moist  tubercle 
bacilli.  If,  then,  this  virus  be  present  in  the  air 
(in  a  measure  'volatile'),  its  introduction  into  the 
mouth  and  so  into  the  intestinal  tract  cannot  be 
avoided. 

"  These  facts  apply  equally  well  to  infants   and 
to  new -bom  calves." 


84  THE   SUPPRESSION  OF   TUBERCULOSIS. 

NOTE    TO    PAGE    5 1. 

Mar.  3,  1904. 

Excellence  E.  von  Behring,  Marburg,  Germany. 
My  dear  Professor  Behring: 

I  have  seen  in  recent  discussion,  reported 
in  the  medical  journals,  a  reference  to  Dr.  Knopf 
in  regard  to  the  infection  of  record-books,  which 
he  attributed  to  an  occurrence  in  the  Health  Bureau 
of  Lansing,  Michigan,  and  seems  to  have  reported 
in  one  of  the  French  journals. 

Dr.  Henry  B.  Baker,  who  is  the  Secretary  of  the 
State  Board  of  Health  of  Michigan,  and  who  is  a 
personal  friend  of  mine,  has  been  applied  to  for 
more  particular  information,  and  it  appears  that  the 
matter  refers  to  a  newspaper  (published  in  Detroit 
Oct.  14,  1899)  and  undoubtedly  refers  to  a  claim  made 
by  some  one  in  Russia,  where  such  an  infection  is 
said  to  have  taken  place. 

I  send  you  herewith  a  copy  of  the  notice  that 
has  been  sent  out  by  the  Lansing  Health  Bureau, 
and  may  say  that  Dr.  Baker  writes  me  that  nothing 
of  the  sort  has  occurred  in  the  office  at  Michigan. 

I  would  be  greatly  pleased  if  you  could  send  me 
a  copy  of  Dr.  Knopf's  publication  in  the  Press 
Medicale  to  which  you  have  referred.  . 

Thanking  you  in  advance,  I  remain 
gincerely  yours, 

Karl  von  Ruck. 


APPENDIX. 


8s 


NOTE   TO    PAGE    75- 

One  unpleasant  possibility  [in  the  making 
of  inoculation]  is  to  be  mentioned,  one  which  I  did 
not  originally  think  of  and  which  was  called  to  my 
attention  by  Ober-med.   Rath  Lorenz.     It  consists 
in  the  general  collapse  of  the  inoculated  calf,   of 
very  threatening  aspect,  when  the  inoculating  fluid 
has  been  injected   too  cold.     This  happened   on   a 
Hessian   farm   on  a  cold  winter  day,  and   resulted 
m   the   collapse   of   all  the  inoculated   calves.     (It 
would,  by  the  way,  have  happened  if  only  the  cold 
fluid  without  the  virus  had  been  injected.)     As  it 
was,  all  the  inoculated  animals  had  recovered  by 
the  following  day.     This  teaches  us  to  warm  the 
inoculating  fluid  to  about  body  temperature  before 
injecting  it.     This  is  readily  done  by  placing  the 
bottle  containing   the  fluid  into  a   little  lukewarm 
water. 


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Craft's  Short  Course  in  Qualitative  Chemical  Analysis.  (Schaeffer.). .    .i2mo,  i  50 

Dolezalek's  Theory    of    the    Lead    Accumulator    (Storage    Bactery).     (Von 

Ende) i2mo.  2  50 

Drechsel's  Chemical  Reactions.     (Merrill.) . ....    . i2mo,  i   25 

Duhem's  Thermodynamics  and  Chemistry.     (Burgess. ) -  .8vo,  4  00 

Eissler's  Modern  High  Explosives .    8vo,  4  00 

EfEront's  Enzymes  and  their  Apphcations.     (Prescott.) . .    8vo,  3  00 

Erdmann's  Introduction  to  Chemical  Preparations.     (Dunlap. ).......  .i2mo»  ^  23 

3 


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25 

2 

25 

2 

00 

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50 

I 

50 

Fletcher's  Practical  Instructions  in  Quantitative  Assaying  with  the  Blowpipe 

i2nio,  morocco,  i  50 

Fowler's  Sewage  Works  Analyses i2mo,  2  00 

Presenius's  Manual  of  Qualitative  Chemical  Analysis.     (Wells.) 8vo,  5  00 

Manual  of  Qualitative  Chemical  Analysis.     Parti.    Descriptive.     (Wells.) 

8vo,  3  00 
System   of   Instruction   in    Quantitative    Chemical   Analysis.      (Cohn.) 

2  vols 8vo,  12  50 

Fuertes's  Water  and  PubUc  Health i2mo,  i  50 

Furman's  Manual  of  Practical  Assaying 8\  0,  3  00 

*Getman's  Exercises  in  Physical  Chemistry i2mo,  2  00 

Gill's  Gas  and  Fuel  Analysis  for  Engineers i2mo,  i  25 

Grotenfelt's  Principles  of  Modern  Dairy  Practice.     (WoU.) i2mo.  2  00 

Hammarsten's  Text-book  of  Physiological  Chemistry.     (Mandel.) 8vo,  4  00 

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Bering's  Ready  Reference  Tables  (Conversion  Factors) i6mo,  morocco,  2  50 

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Hopkins's  Oil-chemists'  Handbook 8vo,  3  00 

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Keep's  Cast  Iron 8vo,  2  50 

Ladd's  Manual  of  Quantitative  Chemical  Analysis I2m0j,  i  00 

Landauer's  Spectrum  Analysis.     (Tingle.) 8vo,  3  00 

Lassar-Cohn's  Practical  Urinary  Analysis.     (Lorenz.) i2mo,  i  00 

Leach's  The  Inspection  and  Analysis  of  Food  with  Special  Reference  to  State 

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•  Martin's  Laboratory  Guide  to  Qualitative  Analysis  with  the  Blowpipe . .  i2mo,  60 
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Meyer's  Determination  of  Radicles  in  Carbon  Compounds.     (Tingle.). . i2mo,  i  00 

Miller's  Manual  of  Assaying i2mo,  i  00 

Mizter's  Elementary  Text-book  of  Chemistry i2mo,  i  50 

Morgan's  Outline  of  Theory  of  Solution  and  its  Results i2mo,  i  00 

Elements  of  Physical  Chemistry i2mo,  2  00 

Morse's  Calculations  used  in  Cane-sugar  Factories i6mo,  morocco,  i  50 

Mulliken's  General  Method  for  the  Identification  of  Pure  Organic  Compounds. 

Vol.  I Large  8vo,  5  00 

Nichols's  Water-supply.     (Considered  mainly  from  a  Chemical  and  Sanitary 

Standpoint,  1883.) 8vo,  2  50 

O'Brine's  Laboratory  Guide  in  Chemical  Analysis 8vo,  2  00 

O'DriscoU's  Notes  on  the  Treatment  of  Gold  Ores 8vo,  2  00 

Ost  and  Kolbeck's  Text-book  of  Chemical  Technology.     (Lorenz — Bozart.) 

(In  preparation.) 
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8vo,  paper,  so 

Pictet's  The  Alkaloids  and  their  Chemical  Constitution.     (Biddle.) 8vo,  5  00 

Pinner's  Introduction  to  Organic  Chemistry.     (Austen.) i2mo»  i  50 

Poole's  Calorific  Power  of  Fuels 8vo,  3  00 

Prescott  and  Winslow's  Elements  of  Water'Bacterlology,  with  Special  Refer- 
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•  Reisig's  Guide  to  Piece-dyeing 8vo,  25  00 

4 


Richards  and  Woodman's  Air  .Water,  and  Food  from  a  Sanitary  Standpoint.  8vo, 

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Cost  of  Food  a  Study  in  Dietaries i2mo, 

•  Richards  and  Williams's  The  Dietary  Computer 8vo, 

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Non-metallic   Elements.) 8vo,  morocco, 

Ricketts  and  Miller's  Notes  on  Assaying Svo, 

Rideal's  Sewage  and  the  Bacterial  Purification  of  Sewage Svo, 

Disinfection  and  the  Preservation  of  Food 8vo, 

Ruddiman's  Incompatibilities  in  Prescriptions 8vo, 

Sabin's  Industrial  and  Artistic  Technology  of  Paints  and  Varnish.  {In  press.) 
Sclkowski's  Physiological  and  Pathological  Chemistry.  (Orndorff.)- •  • -Svo, 
Schimpfs  Text-book  of  Volumetric  Analysis lamo» 

Essentials  of  Volumetric  Analysis i2mo, 

Spencer's  Handbook  for  Chemists  of  Beet-sugar  Houses i6mo,  morocco. 

Handbook  for  Sugar  Manufacturers  and  their  Chemists. .  i6mo,  morocco, 
Stockbridge's  Rocks  and  Soifs 8vo, 

*  Tillman's  Elementary  Lessons  in  Seat 8vo, 

♦  Descriptive  General  Chemistry 8vo, 

Treadwell's  Qualitative  Analysis.     (Hall.) 8vo, 

Quantitative  Analysis.     (Hall.) 8vo, 

Turneaure  and  Russell's  Public  Water-supplies Svo, 

Van  Deventer's  Physical  Chemistry  for  Beginners.     (Boltwood.) i2mo, 

*  Walke's  Lectures  on  Explosives Svo, 

Wassermann's  Immune  Sera:  Haemolysins,  Cytotoxins,  and  Precipitins.     (Bol- 

duan.) i2mo, 

Wells's  Laboratory  Guide  in  Qualitative  Chemical  Analysis Svo, 

Short  Course  ir  Inorganic  Qualitative  Chemical  Analysis  for  Engineering 

Students i2mo, 

Whipple's  Microscopy  of  Drinking-water Svo, 

Wiechmann's  Sugar  Analysis Small  Svo. 

Wilson's  Cyanide  Processes i2mo, 

Chlorination  Process i2mo , 

Wulling's  Elementary  Course  in  Inorganic    harmaceutical  and  Medical  Chem- 
istry  i2mo,    3  oo 

CIVIL  EI^GINEERING. 

BRIDGES  AND    ROOFS.       HYDRAULICS.      MATERIA.LS    OF    ENGINEERING 
RAILWAY  ENGINEERING. 

Baker's  Engineers'  Surveying  Instruments i2mo, 

Bixby's  Graphical  Computing  Table Paper  19^X24^  inches. 

**  Burr's  Ancient  and  Modern  Engineering  and  the  Isthmian  Canal.     (Postage, 

27  cents  additional.) Svo,  net 

Com?tock's  Field  Astronomy  for  Engineers Svo, 

Davis's  Elevation  and  Stadia  Tables Svo, 

Elliott's  Engineering  for  Land  Drainage i2mo. 

Practical  Farm  Drainage i2mo, 

FolweU's  Sewerage.     (Designing  and  Maintenance.) Svo, 

Freitag's  Architectural  Engineering.     2d  Edition,  Rewritten Svo, 

French  and  Ives's  Stereotomy Svo, 

Goodhue's  Municipal  Improvements i2mo, 

Goodrich's  Economic  Disposal  of  Towns'  Refuse Svo, 

Gore's  Elements  of  Geodesy Svo, 

Hayford's  Text-book  of  Geodetic  Astronomy 8vo, 

Hering's  Ready  Reference  Tables  (Conversion  Factors) i6mo,  morocco, 

Howe's  Retaining  WaUs  for  Earth i2mo, 

Johnson's  Theory  and  Practice  of  Surveving Small  Svo, 

Statics  by  Algebraic  and  Graphic  Methods Svo, 

5 


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3 

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5 

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00 

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00 

3 

00 

3 

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3 

50 

z 

75 

3 

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50 

3 

00 

2 

50 

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25 

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2 

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7 

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5 

00 

3 

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5 

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6 

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6 

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5 

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5 

50 

3 

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2 

50 

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4 

00 

3 

50 

Kiersted's  Sewage  Disposal i2mo, 

Laplace's  Philosophical  Essay  on  Probabilities.     (Truscott  and  Emory.)  12010, 
Mahan's  Treatise  on  Civil  Engineering.     (1873,,)     (Wood.) 8vo, 

•  Descriptive  Geometry 8vo, 

Merriman's  Elements  of  Precise  Surveying  and  Geodesy 8vo, 

Elements  of  Sanitary  Engineering 8vo, 

Merriman  and  Brooks's  Handbook  for  Surveyors i6mo,  morocco, 

Nugent's  Plane  Surveying .0 8vo, 

Ogden's  Sewer  Design i2mo, 

Patton's  Treatise  on  Civil  Engineering 8vo  half  leather. 

Reed's  Topographical  Drawing  and  Sketching *. 4to, 

Rideal's  Sewage  and  the  Bacterial  Purification  of  Sewage 8vo, 

Siebert  and  Biggin's  Modern  Stone-cutting  and  Masonry 8vo, 

Smith's  Manual  of  Topographical  Drawing.     (McMillan.) 8vo, 

Sondericker's   Graphic   Statics,  witn  Applications   to   Trusses,  Beams,   and 
Arches 8vo, 

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Wait's  Engineering  and  Architectural  Jurisprudence 8vo, 

Sheep, 
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tecture.  8vo, 

Sheep, 

Law  of  Contracts 8vo, 

Warren's  Stereotomy — Problems  in  Stone-cutting 8vo, 

Webb's  Problems  in  the  Use  and  Adjustment  of  Engineering  Instruments. 

i6mo,  morocco, 

•  Wheeler's  Elementary  Course  of  Civil  Engineering 8vo, 

Wilson's  Topographic  Surveying .8vo, 


BRIDGES  AND  ROOFS. 

Boiler's  Practical  Treatise  on  the  Construction  of  Iron  Highway  Bridges.  .8vo,  2  00 

*         Thames  River  Bridge 4to,  paper,  5  00 

Btirr's  Course  on  the  Stresses  in  Bridges  and  Roof  Trusses,  Arched  Ribs,  and 

Suspension  Bridges ^ , 8vo,  3  50 

Du  Bois's  Mechanics  of  Engineering.     Vol.  II Small  4to,  10  00 

Foster's  Treatise  on  Wooden  Trestle  Bridges 4to,  5  00 

Fowler's  Coffer-dam  Process  for  Piers 8vo,  2  50 

Greene's  Roof  Trusses 8vo,  i  25 

Bridge  Trusses 8vo,  2  «?o 

Arches  in  Wood,  Iron,  and  Stone 8vo,  2  50 

Howe's  Treatise  on  Arches 8vo,  4  00 

Design  of  Simple  Roof-trusses  in  Wood  and  Steel 8vo,  2  00 

Johnson,  Bryan,  and  Turneaure's  Theory  and  Practice  in  the  Designing  of 

Modern  Framed  Structures Small  4to,  10  00 

Merriman  and  Jacoby's  Text-book  on  Roofs  and  Bridges: 

Part  I. — Stresses  in  Simple  Trusses 8vo,  2  50 

Part  n. — Graphic  Statics 8vo,  2  50 

Part  III. — Bridge  Design.     4th  Edition,  Rewritten 8vo,  2  50 

Part  IV. — Higher  Structures 8vo,  2  50 

Morison's  Memphis  Bridge 4to,  10  00 

Waddell's  De  Pontibus,  a  Pocket-book  for  Bridge  Engineers. . .  i6mo,  morocco,  3  00 

Specifications  for  Steel  Bridges i2mo,  i  23 

Wood's  Treatise  on  the  Theory  of  the  Construction  of  Bridges  and  Roofs.Svo,  2  00 
Wright's  Designing  of  Draw-spans: 

Part  I.  — Plate-girder  Draws : 8vo,  2  50 

Part  II. — Riveted-truss  and  Pin-connected  Long-span  Draws 8vo,  2  50 

Two  parts  in  one  volume ,..,,.,. 8vo,  3  50 


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Bazin's  Experiments  upon  the  Contraction  of  the  Liquid  Vein  Issuing  from  an 

Orifice.     (Trautwine.) 8vo,    2  00 

Bovey's  Treatise  on  Hydraulics 8vo,  5  00 

Church's  Mechanics  of  Engineering 8vo,  6  00 

Diagrams  of  Mean  Velocity  of  Water  in  Open  Channels paper,  1  50 

Coffin's  Graphical  Solution  of  Hydraulic  Problems i6mo,  morocco,  2  50 

Flather's  Dynamometers,  and  the  Measurement  of  Power i2mo,  3  00 

Folwell's  Water-supply  Engineering Svo,  4  00 

Frizell's  Water-power Svo,  5  00 

Fuertes's  Water  and  Public  Health i2mo,  1  50 

Water-filtration  Works i2mo,  2  50 

Ganguillet  and  Kutter's  General  Formula  for  the  Uniform  Flow  of  Water  in 

Rivers  and  Other  Channels.     (Hering  and  Trautwine.) Svo,  4  00 

Hazen's  Filtration  of  Public  Water-supply Svo,  3  00 

Hazlehurst's  Towers  and  Tanks  for  Water-works Svo,  2  50 

Herschel's  115  Experiments  on  the  Carrying  Capacity  of  Large,  Riveted,  Metal 

Conduits Svo,  2  00 

Mason's    Water-supply.     (Considered    Principally   from   a   Sanitary   Stand- 
point.)    3d  Edition,  Rewritten Svo,  4  00 

Merriman's  Treatise  on  Hydraulics,     gth  Edition,  Rewritten Svo,  5  00 

*  Michie's  Elements  of  Analytical  Mechanics Svo,  4  00 

Schuyler's  Reservoirs  for  Irrigation,  Water-power,   and  Domestic   Water- 
supply  Large  Svo,  5  00 

♦♦  Thomas  and  Watt's  Improvement  of  Riyers.     (Post.,  44  c.  additional),  4to,  6  00 

Tumeaure  and  Russell's  Public  Water-supplies Svo,  5  00 

Wegmann's  Desien  and  Construction  of  Dams 4to,  5  00 

Water-supply  of  the  City  of  New  York  from  1658  toiSgs 4to,  10  00 

Weisbach's  Hydraulics  and  Hydraulic  Motors.     (Du  Bois.) Svo,  5  00 

Wilson's  Manual  of  Irrigation  Engineering Small  Svo,  4  00 

Wolff's  Windmill  as  a  Prime  Mover Svo,  3  00 

Wood's  Turbines Svo,  2  50 

Elements  of  Analytical  Mechanics Svo,  3  00 

MATERIALS  OF  ENGINEERING. 

Baker's  Treatise  on  Masonry  Construction 8vo,  5  00 

Roads  and  Pavements Svo,  5  00 

Black's  United  States  Public  Works Oblong  4to,  5  00 

Bovey's  Strength  of  Materials  and  Theory  of  Structures Svo,  7  50 

Burr's  Elasticity  and  Resistance  of  the  Materials  of  Engineering.     6th  Edi- 
tion, Rewritten Svo,  7  50 

Byrne's  Highway  Construction Svo,  5  00 

Inspection  of  the  Materials  and  Workmanship  Employed  in  Construction. 

i6mo,  3  00 

Church's  Mechanics  of  Engineering Svo,  6  00 

Du  Bois's  Mechanics  of  Engineering.     VoL  I Small  4to,  7  50 

Johnson's  Materials  of  Construction Large  Svo,  6  00 

Keep's  Cast  Iron Svo,  2  50 

Lanza's  Applied  Mechanics Svo,  7  50 

Martens's  Handbook  on  Testing  Materials.     (Henning.)     2  vols 8vo,  750 

Merrill's  Stones  for  Building  and  Decoration Svo,  5  00 

Merriman's  Text-book  on  the  Mechanics  of  Materials .Svo,  4  00 

Strength  of  Materials i2mo,  i  00 

Metcalf's  Steel.     A  Manual  for  Steel-users i2mo,  2  00 

Patton's  Practical  Treatise  on  Foundations Svo,  5  oq 

7 


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2 

50 

5 

00 

4 

00 

3 

00 

I 

25 

2 

00 

3 

00 

4 

00 

Rockwell's  Roads  and  Pavements  in  France i2mo. 

Smith's  Materials  of  Machines i2mo, 

Snow's  Principal  Species  of  Wood 8vo, 

Spalding's  Hydraulic  Cement i2mo, 

Text-book  on  Roads  and  Pavements i2mo, 

Thurston's  Materials  of  Engineering.     3  Parts Svo, 

art  I. — Non-metallic  Materials  of  Engineering  and  Metallurgy Svo, 

Part  n. — Iron  and  Steel Svo, 

Part  III. — A  Treatise  on  Brasses,  Bronzes,  and  Other  Alloys  and  their 

Constituents Svo, 

Thurston's  Text-book  of  the  Materials  of  Construction Svo, 

Tillson's  Street  Pavements  and  Paving  Materials Svo, 

Waddell's  De  Pontibus,     (A  Pocket-book  for  Bridge  Engineers.) . .  i6mo,  mor.. 

Specifications  for  Steel  Bridges. i2mo. 

Wood's  Treatise  on  the  Resistance  of  Materials,  and  an  Appendix  on  the  Pres- 
ervation of  Timber Svo, 

Elements  of  Analytical  Mechanics Svo, 

Wood's  Rustless  Coatings:  Corrosion  and  Electrolysis  of  Iron  and  Steel.  .  .Svo, 

RAILWAY  ENGINEERING. 

Andrews's  Handbook  for  Street  Railway  Engineers.     3XS  inches,  morocco,  i  25 

Berg's  Buildings  and  Structures  of  American  Railroads. 4to,  5  00 

Brooks's  Handbook  of  Street  Railroad  Location i6mo,  morocco,  i  50 

Butts's  Civil  Engineer's  Field-book i6mo,  morocco,  2  50 

Crandall's  Transition  Curve i6mo,  morocco,  i  50 

Railway  and  Other  Earthwork  Tables Svo,  i  50 

Dawson's  "Engineering"  and  Electric  Traction  Pocket-book.    i6mo,  morocco,  5  00 

Dredge's  History  of  the  Pennsylvania  Railroad:   (1S79) Paper,  5  00 

•  Drinker's  Tunneling,  Explosive  Compounds,  and  Rock  Drills,  4to,  half  mor.,  25  00 

Fisher's  Table  of  Cubic  Yards Cardboard,  25 

Godwin's  Railroad  Engineers'  Field-book  and  Explorers'  Guide i6mo,  mor.,  2  50 

Howard's  Transition  Curve  Field-book i6mo,  morocco.  1  so 

Hudson's  Tables  for  Calculating  the  Cubic  Contents  of  Excavations  and  Em- 
bankments   Svo,  I    DO 

Molitor  and  Beard's  Manual  for  Resident  Engineers i6mo,  i  00 

Nagle's  Field  Manual  for  Railroad  Engineers i6mo  morocco.  3  00 

Philbrick's  Field  Manual  for  Engineers i6mo,  morocco,  3  00 

Searles*s  Field  Engineering i6mo,  morocco,  3  00 

Railroad  Spiral i6mo,  morocco,  i  50 

Taylor's  Prismoidal  Formulae  and  Earthwork Svo,  1  50 

•  Trautwine's  Method  of  Calculating  the  Cubic  Contents  of  Excavations  and 

Embankments  by  the  Aid  of  Diagrams Svo,  2  00 

The  Field  Practice  of  JLaying    Out    Circular    Curves   for   Railroads. 

i2mo,  morocco,  2  50 

Cross-section  Sheet.  1 Paper,  25 

Webb's  Railroad  Construction.     2d  Edition,  Rewritten i6mo.  morocco,  5  00 

Wellington's  Economic  Theory  of  the  Location  of  Railways Small  Svo,  5  00 

DRAWING. 

Barr's  Kinematics  of  Machinery Svo,    2  50 

•  Bartlett's  Mechanical  Drawing Svo,    3  00 

•  "  *  "         Abridged  Ed Svo,    i  50 

Coolidge's  Manual  of  Drawing Svo,  paper,    i  00 

Coolidge  and  Freeman's  Elements  of  General  Drafting  for  Mechanical  Engi- 
neers.    (In  press.) 

Durley's  Kinematics  of  Machines '.Svo,   4  00 

8 


Hill's  Text-book  on  Shades  and  Shadows,  and  Perspective , 8vo, 

Jamison's  Elements  of  Mechanical  Drawing.     {In  press.) 

/ones's  Machine  Design: 

Part  I. — Kanematics  of  Machinery 8vo, 

Part  II. — Form,  Strength,  and  Proportions  of  Parts 8vo» 

MacCord's  Elements  of  Descriptive  Geometr> , 8vo, 

Kinematics;   or.  Practical  Mechanism 8vo, 

Mechanical  Drawing 4to, 

Velocity  Diagrams 8vo, 

♦  Mahan's  Descriptive  Geometry  and  Stone-cutting , 8vo, 

Industrial  Drawing.    (Thompson.) 8vo, 

Reed's  Topographical  Drawing  and  Sketching 4to, 

Raid's  Cotirse  in  Mechanical  Drawing 8vo, 

Text-book  of  Mechanical  Drawing  and  Elementary  Machine  Design.  .8vo, 

Robinson's  Principles  of  Mechanism 8vo, 

Smith's  Manual  of  Topographical  Drawing.     (McMillan.) 8vo, 

Warren's  Elements  of  Plane  and  Solid  Free-hand  Geometrical  Drawing. .  i2mo. 

Drafting  Instruments  and  Operations lamo, 

Manual  of  Elementary  Projection  Drawing i2mo, 

Manual  of  Elementary  Problems  in  the  Linear  Perspective  of  Form  and  B 

Shadow i2mo, 

Plane  Problems  in  Elementary  Geometry lamo, 

Primary  Geometry i2mo. 

Elements  of  Descriptive  Geometry,  Shadows,  and  Perspective 8vo, 

General  Problems  of  Shades  and  Shadows 8to, 

Elements  of  Machine  Construction  and  Drawing 8vo, 

Problems.  Theorems,  and  Examples  in  Descriptive  Geometrv 8vo, 

Weisbach's  Kinematics  and  the  Power  of  Transmission.       (Hermaim  and 

Klein.) 8vo, 

Whelpley's  Practical  Instruction  in  the  Art  of  Letter  Engraving i2mo, 

Wilson's  Topographic  Surveying 8vo, 

Free-hand  Perspective 8vo, 

Free-hand  Lettering 8vo, 

Woolf's  Elementary  Course  in  Descriptive  Geometry. Large  8vo, 

ELECTRICITY  AND   PHYSICS. 

Anthony  and  Brackett's  Text-book  of  Physics.    (Magie.) , . .  .Small  8vo, 

Anthony's  Lecture-notes  on  the  Theory  of  Electrical  Measurements I2m0t 

Benjamin's  History  of  Electricity 8vo. 

Voltaic  Cell 8vo, 

Classen's  Quantitative  Chemical  Analysis  by  Electrolysis.    (Boltwood.).  .8vo, 

Crehore  and  Squier's  Polarizing  Photo-chronograph 8vo, 

Dawson's  "Eneineering"  and  Electric  Traction  Pocket-book. .  i6mOt  morocco, 
Dolezalek's    Theory  of    the    Lead   Accumulator    (Storage    Battery).     (Von 

Ende.) i2mo,': 

Duhem's  Thermodynamics  and  Chemistry.     (Burgess.) 8vo, 

Flather's  Dvnamometers,  and  the  Measurement  of  Power i2mo, 

Gilbert's  De  Magnete.     (Mottelay.) 8vo, 

Hanchett's  Alternating  Currents  Explained i2mo, 

Hering's  Ready  Reference  Tables  (Conversion  Factors). .....  i6mo,  morocco, 

Holman's  Precision  of  Measurements 8vo, 

Telescopic  Mirror-scale  Method,  Adjustments,  and  Tests Large  8vo, 

Landauer's  Spectrum  Analysis.    (Tingle.) 8vo, 

Le  Chatelier's  High-temperature  Measurements.  (Boudouard — J3urgess.)i2mo, 
Lob's  Electrolysis  and  Electrosynthesis  of  Organic  Compounds.  (Lorenz.)  i2mo. 

♦  Lyons's  Treatise  on  Electromagnetic  Phenomena.     Vols.  I.  and  II.  iJvo,  each. 

♦  Michie.     Elements  of  Wave  Motion  Relating  to  Sound  and  Light 8vo, 

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Niaudet's  Elementary  Treatise  on  Electric  Batteries.     (Fishoack. ) lamo,  2  50 

•  Rosenberg's  Electrical  Engineering.   (Haldane  Gee — Kinzbrunner.). . .  .8vo,  i  50 

Ryan,  Norris,  and  Hoxie's  Electrical  Machinery.     VoL  1 8vo,  2  50 

Thurston's  Stationary  Steam-engines 8vo,  2  50 

•  Tillman's  Elementary  Lessons  in  Heat Svo,  i  50 

Tory  and  Pitcher's  Manual  of  Laboratory  Physics. Small  Svo,  2  00 

Ulke's  Modern  Electrolytic  Copper  Refining 8vo,  3  00 


LAW. 

*  Davis's  Elements  of  Law , 8vo, 

*  Treatise  on  the  Military  Law  of  United  States 8vo, 

*  Sheep, 

Manual  for  Courts-martial i6mo,  morocco, 

Wait's  Engineering  and  Architectural  Jurisprudence 8vo, 

Sheep, 
Law  of  Operations  Preliminary  to  Construction  in  Engineering  and  Archi- 
tecture      8vo, 

Sheep, 

Law  of  Contracts 8vo, 

Winthrop's  Abridgment  of  Military  Law i2mo, 

MANUFACTURES. 

Bernadou's  Smokeless  Powder — Kitro-cellulose  and  Theory  of  the  Cellulose 

Molecule i2mo, 

Bolland's  Iron  Founder i2mo, 

**  The  Iron  Founder,"  Supplement. i2mo. 

Encyclopedia  of  Founding  and  Dictionary  of  Foundry  Terms  Used  in  the 

Practice  of  Moulding i2mo, 

Eissler's  Modem  High  Explosives 8vo, 

Effront's. Enzymes  and  their  Applications.     (Prescott.) 8vo, 

Fitzgerald's  Boston  Machinist i8mo, 

Ford's  Boiler  Making  for  Boiler  Makers iSmo, 

Hopkins's  Oil-chemists*  Handbook 8vo, 

Keep's  Cast  Iron 8vo, 

Leach's  The  Inspection  and  Analysis  of  Food  with  Special  Reference  to  State 

Control.     (In  preparation.) 

Metcalf 's  SteeL    A  Manual  for  Steel-users i2mo, 

Metcalfe's  Cost  of  Manufactm-es — And  the  Administration    of  Workshops, 

Public'  and  Private 8vo, 

Meyer's  Modern  Locomotive  Construction 4to, 

Morse's  Calculations  used  in  Cane-sugar  Factories i6mo,  morocco, 

*  Reisig's  Guide  to  Piece-dyeing Svo, 

Smith's  Press-working  of  Metals Svo, 

Spalding's  Hydraulic  Cement i2mo, 

Spencer's  Handbook  for  Chemists  of  Beet-sugar  Houses i6mo,  morocco. 

Handbook  tor  sugar  Manutacturers  and  their  Chemists.. .  i6mo,  morocco, 
Thurston's  Manual  of  Steam-boilers,  their  Designs,  Construction  and  Opera- 
tion  , Svo, 

*  Walke's  Lectures  on  Explosives Svo, 

West's  American  Foundry  Practice i2mo. 

Moulder's  Text-book i2mo, 

Wiechmann's  Sugar  Analysis Small  Svo, 

Wolff's  Windmill  as  a  Prime  Mover 8vo, 

Woodbury's  Fire  Protection  of  Mills 8vo, 

Wood's  Rustless  Coatings:  Corrosion  and  Electrolysis  of  Iron  and  Steel.  .  .Svo, 

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MATHEMATICS. 

Baker's  Elliptic  Functions 8vo, 

•  Bass's  Elements  of  Differential  Calculus i2mo, 

Briggs's  Elements  of  Plane  Analytic  Geometry i2mo, 

Compton's  Manual  of  Logarithmic  Computations i2mo, 

Davis's  Introduction  to  the  Logic  of  Algebra 8vo, 

*  Dickson's  College  Algebra Large  i2mo, 

*  Answers  to  Dickson's  College  Algebra 8vo,  paper, 

♦  Introduction  to  the  Theory  of  Aiggebraic  Equations   Large  i2mo, 

Halsted's  Elements  of  Geometry Svo. 

Elementary  Synthetic  Geometry 8vo, 

Rational  Geometry , i2mo, 

•  Johnson's  Three-place  Logarithmic  Tables :    Vest-pocket  size paper, 

loo  copies  for 

•  Mounted  on  heavy  cardboard,  8  X  lo  inches, 

lo  copies  for 

Elementary  Treatise  on  the  Integral  Calculus Small  8vo, 

,       Curve  Tracing  in  Cartesian  Co-ordinates i2mo. 

Treatise  on  Ordinary  and  Partial  Differential  Equations Small  8vo, 

Theory  of  Errors  and  the  Method  of  Least  Squares i2mo, 

*  Theoretical  Mechanics i2mo, 

Laplace's  Philosophical  Essay  on  Probabilities.     (Truscott  and  Emory.)  i2mo, 

*  Ludlow  and  Bass.     Elements  of  Trigonometry  and  Logarithmic  and  Other 

Tables 8vo, 

Trigonometry  and  Tables  published  separately Each, 

*  Ludlow's  Logarithmic  and  Trigonometric  Tables Svo, 

Maurer's  Technical  Mechanics 8vo, 

Merriman  and  Woodward's  Higher  Mathematics 8vo, 

Merriman's  Method  of  Least  Squares 8vo, 

Rice  and  Johnson's  Elementary  Treatise  on  the  Differential  Calculus. Sm.,  8vo, 

Differential  and  Integral  Calculus.     2  vols,  in  one Gmall  8vo, 

Sabin's  Industrial  and  Artistic  Technology  of  Paints  and  Varnish.  {In  press.) 
Wood's  Elements  of  Co-ordinate  Geometry 8vo, 

Trigonometry:  Analytical,  Plane,  and  Spherical i2mo, 

MECHANICAL   ENGINEERING. 

MATERIALS  OF  ENGINEERING,  STEAM-ENGINES  AND  BOILERS. 

Baldwin's  Steam  Heating  for  Buildings i2mo, 

Barr's  Kinematics  of  Machinery 8vo, 

•  Bartlett's  Mechanical  Drawing 8vo, 

♦  "  "  "        Abridged  Ed 8vo, 

Benjamin's  Wrinkles  and  Recipes i2mo. 

Carpenter's  Experimental  Engineering 8vo, 

Heating  and  Ventilating  Buildings 8vo, 

Gary's  Smoke  Suppression  in  Plants  using  Bituminous  CoaL      (7n  prep- 
aration.) 

Clerk's  Gas  and  Oil  Engine Small  8vo, 

Coolidge's  Manual  of  Drawing 8vo,    paper, 

Coolidge  and  Freeman's  Elements  of  General  Drafting  for  Mechanical  En- 
gineers.    (In  press.) 

Cromwell's  Treatise  on  Toothed  Gearing i2mo.. 

Treatise  on  Belts  and  Pulleys i2mo, 

Durley's  Kinematics  of  Machines 8vo, 

Flather's  Dynamometers  and  the  Measurement  of  Power i2mo. 

Rope  Driving i2mo, 

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Gill's  Gas  and  Fuel  Analysis  for  Engineers c i2mo. 

Hall's  Car  Lubrication , i2mo, 

Hering's  Ready  Reference  Tables  (Conversion  Factors) lömo,  morocco, 

Hutton's  The  Gas  Engine 8vo, 

Jones's  Machine  Design: 

Part   I. — Kinematics  of  Machinery 8vo, 

Part  II. — Form,  Strength,  and  Proportions  of  Parts 8vo, 

Kent's  Mechanical  Engineer's  Pocket-book i6mo,    morocco, 

Kerr's  Power  and  Power  Transmission Svo, 

MacCord's  Kinematics;  or.  Practical  Mechanism Svo, 

Mechanical  Drawing 4to, 

Velocity  Diagrams 8vo, 

Mahan's  Industrial  Drawing.    (Thompson.) 8vo, 

Poole's  Calorific  Power  of  Fuels 8vo, 

Reid's  Course  in  Mechanical  Drawing » 8vo. 

Text-book  of  Mechanical  Drawing  and  Elementary  Machine  Design,  .8vo, 

Richards's  Compressed  Air i2mo, 

Robinson's  Principles  of  Mechanism 8vo, 

Smith's  Press-working  of  Metals 8vo, 

Thurston's  Treatise  on   Friction  and    Lost  Work  in   Machinery  and  Mill 

Work 8vo, 

Animal  as  a  Machine  and  Prime  Motor,  and  the  Laws  of  Energetics.  i2mo, 

Warren's  Elements  of  Machine  Construction  and  Drawing 870, 

Weisbach's  Elinematics  and  the  Power  of  Transmission.      Herrmann — 

Klein.) 8vo, 

Machinery  of  Transmission  and  Governors.     (Herrmann — Klein.).  .8vo, 

HydrauLcs  and  Hydraulic  Motors.     (Du  Bois.) 8vo, 

Wolff's  Windmill  as  a  Prime  Mover 8vo, 

Wood's  Turbines 8vo, 

MATERIALS  OF  ENGINEERING. 

Bovey's  Strength  of  Materials  and  Theory  of  Structures ., 8vo,    7  50 

Burr's  Elasticity  and  Resistance  of  the  Materials  of  Engineering.     6th  Edition, 

Reset 8vo, 

Church's  Mechanics  of  Engineering 8vo, 

Johnson'«  Materials  of  Construction Large  8vo, 

Keep's  Cast  Iron 8vo, 

Lanza's  Applied  Mechanics 8vo, 

Martens's  Handbook  on  Testing  Materials.     (Henning.) 8vo, 

Merriman's  Text-book  on  the  Mechanics  of  Materials 8vo, 

Strength  of  Materials i2mo, 

Metcalf' s  SteeL     A  Manual  for  Steel-users i2mo. 

Smith's  Materials  of  Machines i2mo- 

rhxirston's  Materials  of  Engineering 3  vols. ,  Svo, 

Part   n. — Iron  and  Steel 8vo, 

Part  in. — A  Treatise  on  Brasses,  Bronzes,  and  Other  Alloys  and  their 
Constituents 8vo 

Text-book  of  the  Materials  of  Construction 8vo, 

Wood's  Treatise  on  the  Resistance  of  Materials  and  an  Appendix  on  the 
Preservation  of  Timber 8vo, 

Elements  of  Analytical  Mechanics 8vo, 

Wood's  Rustless  Coatings:  Corrosion  and  Electrolysis  of  Iron  and  Steel. .  .  8vo, 

STEAM-ENGINES  AND   BOILERS. 

Camot's  Reflections  on  the  Motive  Power  of  Heat.     (Thurston.) i2mo, 

Dawson's  "Engineering"  and  Electric  Traction  Pocket-book.  .i6mo,  mor.. 

Ford's  Boiler  Making  for  Boiler  Makers , i8mo, 

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Goss's  Locomotive  Sparks 8vo,    2  00 

Hemenway's  Indicator  Practice  and  Steam-engine  Economy i2mo,    a  00 

Button's  Mechanical  Engineering  of  Power  Plants 8vo,    5  00 

Heat  and  Heat-engines 8vo,    5  oo 

Kent's  Steam-boiler  Economy 8vo,    4  00 

Kneass's  Practice  and  Theory  of  the  Injector 8vo     i  50 

MacCord's  Slide-valves 8vo,    2  00 

Meyer's  Modern  Locomotive  Construction 4to,    10  00 

Peabody's  Manual  of  the  Steam-engine  Indicator i2mo,    i  50 

Tables  of  the  Properties  of  Saturated  Steam  and  Other  Vapors 8vo,    i  00 

Thermodynamics  of  the  Steam-engine  and  Other  Heat-engines 8vo,    5  00 

Valve-gears  for  Steam-engines 8vo,    2  50 

Peabody  and  Miller's  Steam-boilers 8vo,    4  00 

Pray's  Twenty  Years  with  the  Indicator Large  8vo,    2  50 

Pupln's  Thermodynamics  of  Reversible  Cycles  in  Gases  and  Saturated  Vapors. 

(Osterberg.) ; i2mo,  i  25 

Reagan's  Locomotives :  Simple,  Compound,  and  Electric i2mo,  2  50 

Rontgen's  Principles  of  Thermodynamics.     (Du  Bois.) 8vo,    5  00 

Sinclair's  Locomotiv^o  Engine  Running  and  Management i2mo,    2  00 

Smart's  Handbook  of  Engineering  Laboratory  Practice i2mo,    2  50 

Snow's  Steam-boiler  Practice 8vo,    3  00 

Spangler's  Valve-gears 8vo,    2  50 

Notes  on  Thermodynamics i2mo,    i  00 

Spangler,  Greene,  and  Marshall's  Elements  of  Steam-engineering 8vo,    3  00 

Thurston's  Handy  Tables 8vo,    1   50 

Manual  of  the  Steam-engine 2  vols..  8vo,  10  00 

Part  I. — History,  Structuce,  and  Theory 8vo,    6  00 

Part  n. — Design,  Construction,  and  Operation 8vo,    6  00 

Handbook  of  Engine  and  Boiler  Trials,  and  the  Use  of  the  Indicator  and 

the  Prony  Brake 8vo     s  00 

Stationary  Steam-engines 8vo,    2  50 

Steam-boiler  Explosions  in  Theory  and  in  Practice i2mo     i  50 

Manual  of  Steam-boilers ,  Their  Designs,  Construction,  and  Operation .  8vo,    5  00 

Weisbach's  Heat,  Steam,  and  Steam-engines.     (Du  Bois.) 8vo,    5  00 

Whitham's  Steam-engine  Dasign 8vo,    5  00 

Wilson's  Treatise  on  Steam-boilers.     (Flather.) i6mo,    2  50 

Wood's  Thermodynamics   Heat  Motors,  and  Refrigerating  Machines. . .  .8vo,    4  00 


MECHANICS    AND  MACHINERY. 


Barr's  Kinematics  of  Machinery Svo, 

Bovey's  Strength  of  Materials  and  Theory  of  Structures 8vo, 

Chase's  The  Art  of  Pattern-making i2mo, 

ChordaL — Extracts  from  Letters i2mo. 

Church's  Mechanics  of  Engineering 8vo, 

Notes  and  Examples  in  Mechanics 8vo, 

Compton's  First  Lessons  in  Metal-working i2mo, 

Compton  and  De  Groodt's  The  Speed  Lathe i2mo, 

Cromwell's  Treatise  on  Toothed  Gearing i2mo, 

Treatise  on  Belts  and  Pulleys i2mo, 

Dana's  Text-book  of  Elementary  Mechanics  for  the  Use  of  Colleges  and 

Schools i2mo. 

Dingey's  Machinery  Pattern  Making i2mo. 

Dredge's  Record  of  the  Transportation   Exhibits  Building  of  the  World's 

Columbian  Exposition  of  1893 4to,  half  morocco,    5  00 

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Du  Bos's  Elementary  Principles  of  Mechanics: 

Vol.     I. — Kinematics 8vo,  3  50 

Vol     II. — Statics 8vo,  4  00 

Vol.  III. — Kinetics 8vo,  3  50 

Mechanics  of  Engineering.     Vol.   I Small  4to,  7  5o 

VoL  n Small  4to,    10  00 

Durley's  Kinematics  of  Machines   8vo,  4  00 

Fitzgerald's  Boston  Machinist i6mo,  i  00 

Flather's  Dynamometers,  and  the  Measurement  of  Power i2mo,  3  00 

Rope  Driving i2mo,  2  00 

Goss's  Locomotive  Sparks 8vo  2  00 

Hall's  Car  Lubrication i2mo,  i  00 

Holly's  Art  oi  Saw  Filing iSrao,  75 

*  Johnson's  Theoretical  Mechanics 121110,  3  00 

Statics  by  Graphic  and  Algebraic  Methods 8vo,  2  00 

Jones's  Machine  Design: 

Part   I. — Kinematics  of  Machinery 8vo,  i  50 

Part  II. — Form,  Strength,  and  Proportions  of  Parts 8vo,  3  00 

Kerr's  Power  and  Power  Transmission 8vo,  3  00 

Lanza's  Applied  Mechanics 8vo,  7  50 

MacCord's  Kinematics;  or.  Practical  Mechanism 8vo,  5  00 

Velocity  Diagrams 8vo,  x  50 

Maurer's  Technical  Mechanics 8vo,  4  00 

Merriman's  Tert-book  on  the  Mechanics  of  Materials ,8vo,  4  00 

•  Michie's  Elements  of  Analjrtical  Mechanics 8vo,  4  00 

Reagan's  Locomotives:  Simple,  Compound,  and  Electric i2mo,  2  50 

Reid's  Course  in  Mechanical  Drawing 8vo,  2  00 

Text-book  of  Mechanical  Drawing  and  Elementary  Machine  Design.  .8vo,  3  00 

Richards's  Compressed  Air i2mo,  i  50 

Robinson's  Principles  of  Mechanism 8vo,  3  00 

Ryan,  Norris,  and  Hoxie's  Electrical  Machinery.     Vol.  1 8vo,  2  50 

Sinclair's  Locomotive-engine  Running  and  Management l2mo,  2  00 

Smith's  Press-working  of  Metals 8vo,  3  00 

Materials  of  Machines i2mo,  x  00 

Spangler,  Greene,  and  Marshall's  Elements  of  Steam-engineering 8vo,  3  00 

Thurston's  Treatise  on  Friction  and  Lost  Work  in  Machinery  and  Mill 

Work 8vo,  3  00 

Animal  as  a  Machine  and  Prime  Motor,  and  the  Laws  of  Energetics.  i2mo,  i  00 

Warren's  Elements  of  Machine  Construction  and  Drawing 8vo,  7  50 

Weisbach's    Kinematics    and    the  Power  of    Transmission.     (Herrmann — 

Klein.) , 8vo,  5  00 

Machinery  of  Transmission  and  Governors.     (Herrmann — Klein.). 8 vo,  5  00 

Wood's  Elements  of  Analytical  Mechanics 8vo,  3  00 

Principles  of  Elementary  Mechanics i2mo,  i  2S 

Turbines 8vo,  2  50 

The  World's  Columbian  Exposition  of  1893 4to,  i  00 

METALLURGY. 

Egleston's  Metallurgy  of  Silver,  Gold,  and  Mercury: 

Vol.   I.— Silver 8vo,  7  5o 

Vol.   n. — Gold  and  Mercury 8vo,  7  50 

**  Iles's  Lead-smelting.     (Postage  9  cents  additional.) i2mo,  2  50 

Keep's  Cast  Iron 8vo,  2  50 

Kunhardt's  Practice  of  Ore  Dressing  in  Europe .8vo,  i  50 

Le  Chatelier's  High-temperature  Measurements.  (Boudouard — Burgess.) .  i2mo,  3  00 

Metcalf's  SteeL     A  Manual  for  Steel-users i2mo,  2  00 

Smith's  Materials  of  Machines i2mo,  x  00 

14. 


Thurston's  Materials  of  Engineering.     In  Three  Parts 8vo,  8  oo 

Part   II. — Iron  and  Steel 8vo,  3  50 

Part  III. — A  Treatise  on  Brasses»  Bronzes,  and  Other  Alloys  and   their 

Constituents 8vo,  2  50 

Ulke's  Modem  Electrolytic  Copper  Refining Svo,  3  00 

MINERALOGY. 

Barringer's  Description  of  Minerals  of  Commercial  Value.     Oblong,  morocco,  2  50 

Boyd's  Resources  of  Southwest  Virginia 8vo,  3  00 

Map  of  Southwest  Virginia Pocket-book  form,  2  00 

Brush's  Manual  of  Determinative  Mineralogy.     (Penfield.) 8vo,  4  00 

Chester's  Catalogue  of  Minerals 8vo,  paper,  i  00 

Cloth,  I  25 

Dictionary  of  the  Names  of  Minerals 8vo,  3  50 

Dana's  System  of  Mineralogy Large  8vo,  half  leather,    12  50 

First  Appendix  to  Dana's  New  "System  of  Mineralogy.". . .  .Large  8vo,  i  00 

Text-book  of  Mineralogy 8vo,  4  00 

Minerals  and  How  to  Study  Them. . .  = i2mo,  i  50 

Catalogue  of  American  Localities  of  Minerals Large  8vo,  i  00 

Manual  of  Mineralogy  and  Petrography i2mo,  2  00 

Eakle's  Mineral  Tables 8vo,  i  25 

Egleston's  Catalogue  of  Minerals  and  Synon3rms 8vo,  2  50 

Hussak's  The  Determination  of  Rock-forming  Minerals.     (Smith.)  Small  8vo,  2  00 

Merrill's  Non-metallic  Minerals:  Their  Occurrence  and  Uses 8vo,  4  00 

*  Penfield's  Notes  on  Determinative  Mineralogy  and  Record  of  Mineral  Tests. 

8vo,  paper,  o  50 
Rosenbusch's   Microscopical  Physiography   of   the   Rock-making   Minerals. 

(Iddings.) 8vo,  5  00 

♦  Tillman's  Text-book  of  Important  Minerals  and  Docks. 8vo,  2  00 

Williams's  Manual  of  Lithology 8vo,  3  00 

MHONG. 

Beard's  Ventilation  of  Mines i2mo,  2  50 

Boyd's  Resources  of  Southwest  Virginia 8vo,  3  00 

Map  of  Southwest  Virginia Pocket-book  form,  2  00 

♦  Drinker's  Tunneling,  Explosive  Compounds,  and  Rock  Drills. 

4to,  half  morocco,    2S  00 

Eissler's  Modem  High  Explosives 8vo, 

Fowler's  Sewage  Works  Analyses i2mo, 

Goodyear 's  Coal-mines  of  the  Western  Coast  of  the  United  States i2mo, 

Ihlseng's  Manual  of  Mining 8vo, 

**  Iles's  Lead-smelting.     (Postage  gc.  additionaL) i2mo, 

Ktmhardt's  Practice  of  Ore  Dressing  in  Europe 8vo, 

O'Driscoll's  Notes  on  the  Treatment  of  Gold  Ores 8vo, 

*  Walke's  Lectures  on  Explosives 8vo, 

Wilson's  Cyanide  Processes i2mo, 

Chlorination  Process i2mo. 

Hydraulic  and  Placer  Mining i2mo. 

Treatise  on  Practical  and  Theoretical  Mine  Ventilation i2mo 

SANITARY  SCIENCE. 

Copeland's  Manual  of  Bacteriology.     (In  preparation.) 

Folwell's  Sewerage.     (Designing,  Construction  and  Maintenance.; 8vo,  3  00 

Water-supply  Engineering 8vo,  4  00 

Fuertes's  Water  and  PubUc  Health l2mo,  1  50 

Water-filtration   Works X2mo,  2  50 

.       15 


4 

00 

2 

00 

2 

50 

4 

00 

2 

50 

I 

50 

2 

00 

4 

00 

I 

50 

I 

SO 

2 

00 

I 

25 

4 

oo 

I 

25 

2 

OO 

2 

so 

2 

oo 

I 

25 

I 

50 

I 

00 

X 

00 

a 

00 

I 

so 

3 

50 

5 

00 

3 

so 

z 

so 

Gerhard's  Guide  to  Sanitary  House-inspection i6mo,    1  00 

Goodrich's  Economical  Disposal  of  Town's  Refuse Demy  8vo,    3  50 

Hazen's  Filtration  of  Public  Water-supplies 8vo,    3  00 

Kiersted's  Sewage  Disposal i2mo,    i  25 

Leach's  The  Inspection  and  Analysis  of  Food  with  Special  Reference  to  State 

ControL     (In  preparation.) 
Mason's   Water-supply.     (Considered   Principally   from   a   Sanitary   Stand- 
point.)    3d  Edition,  Rewritten 8vo, 

Examination  of  Water.     (Chemical  and  BacteriologicaL) i2mo, 

Merriman's  Elements  of  Sanitary  Engineering , 8vo, 

Nichols's  Water-supply.     (Considered  Mainly  from  a  Chemical  and  Sanitary 

Standpoint.)     (1883.) .8vo, 

Ogden's  Sewer  Design i2mo, 

Prescott  and  Winslow's  Elements  of  Water  Bacteriology,  with  Special  Reference 
to  Sanitary  Water  Analysis.  ,    lamo, 

*  Price's  Handbook  on  Sanitation i2mo, 

Richards'.  Cost  of  Food.    A  Study  in  Dietaries i2mo. 

Cost  of  Living  as  Modified  by  Sanitary  Science i2mo, 

Richards  and  Woodman's  Air,  Water,  and  Food  from  a  Sanitary  Stand- 
point  8vo, 

*  Richards  and  Williams's  The  Dietary  Computer 8vo, 

Rideal's  Sewage  and  Bacterial  Purification  of  Sewage 8vo, 

Turneaure  and  Russell's  Public  Water-supplies 8vo, 

Whipple's  Microscopy  of  Drinking-water 8vo, 

Woodhull's  Notes  and  Military  Hygiene i6mo, 


MISCELLANEOUS. 

Barker's  Deep-sea  Soundings 8vo,  2  00 

Emmons's  Geological  Guide-book  of  the  Rocky  Mountain  Excursion  of  the 

International  Congress  of  Geologists , Large  8vc  i  50 

Ferrel's  Popular  Treatise  on  the  Winds 8vo  4  00 

Haines's  American  Railway  Management I2mo^  2  50 

Mott's  Composition,  Digestibility,  and  Nutritive  Value  of  Food.   Mounted  chart,  i  25 

Fallacy  of  the  Present  Theory  of  Sound i6mo  i  00 

Ricketts's  History  of  Rensselaer  Pol3rtechnic  Institute,  1824-1894.  Small  8vo,  3  00 

Rotherham's  Empüasized  New  Testament Large  8vo,  2  00 

Steel's  Treatise  on  the  Diseases  of  the  Dog 8vo,  3  50 

Totten's  Important  Question  in  Metrology 8vo  2  50 

The  World's  Columbian  Exposition  ot  1893 4to,  I  00 

Worcester  and  Atkinson.     Small  Hospitals,  Establishment  and  Maintenance, 
and  Suggestions  for  Hospital  Architecture,  with  Plans  for  a  Small 

Hospital i2mo,  i  25 


HEBREW  klTD  CHALDEE   TEXT-BOOKS. 

Green's  Grammar  of  the  Hebrew  Language 8vo,  3  00 

Elementary  Hebrew  Grammar i2mo,  i  25 

Hebrew  Chrestomathy 8vo,  2  00 

Gesenius's  Hebrew  and  Chaldee  Lexicon  to  the  Old  Testament  Scriptures. 

(Tregelles.) Small  4to,  half  morocco,  5  00 

Lett«  Tis'»  Hebrew  Bible 8vo,  2  25 

16 


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